Sometimes there are steps you need to take before you receive care that could affect whether your health insurance plan pays your claim.

Do you need a referral?

Some plans require you to choose a primary care provider (PCP). Your PCP oversees your care and coordinates your care with other doctors. So, if you need to see a specialist, your first step would be a visit with your PCP to get a referral.

If you don’t get a referral first, your health plan can deny the claim. There are some exceptions, such as for emergency care.

Not sure if your plan requires referrals? Log into My Health Toolkit^® to review your Eligibility and Benefits. You can review what your plan covers and what requirements might be in place for different types of services.

What is prior authorization?

In some situations, your plan may require you to get prior authorization. This is a process that allows us to review whether a service or medication is medically necessary before the plan agrees to cover it. There may be other treatment options available. Some may even lower your out-of-pocket costs.

You must complete the prior authorization process before receiving the service or medication. There are some exceptions, such as for emergency care.

You can check the status of a prior authorization request through My Health Toolkit. Log in, and then go to Health, select Benefits and then Authorization Status.