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Some procedures (For instance, an MRI, CAT scan or surgery.) need approval in advance. Your doctor can ask for this approval up to six months ahead of time. You can share a copy of this guide with your doctor.

Aetna Better Health® of California requires prior authorization for select acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services. A current list of the services that require authorization is available on ProPAT, our online prior authorization search tool.

Aetna Better Health® of California requires prior authorization for select acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services. A current list of the services that require authorization is available on ProPAT, our online prior authorization search tool.

The prior authorization process helps ensure that you are receiving quality, effective, safe, and timely care that is medically necessary. All decisions are backed by the latest scientific evidence and our board-certified medical directors.

An Exclusive Provider Organization (EPO) is a lesser-known plan type. Like HMOs, EPOs cover only in-network care. But the networks are generally larger. They may or may not require referrals from a primary care physician. Premiums are higher than HMOs, but lower than PPOs.

Your health insurance company uses a prior authorization requirement as a way of keeping healthcare costs in check. By using prior authorization, your insurer wants to make sure that: You really need it: The service or drug you're requesting must be truly medically necessary.

16 Tips That Speed Up The Prior Authorization Process Sign up for payor newsletters. Stay informed of changing industry standards. Designate prior authorization responsibilities to the same staff member(s). Inform scheduling staff about procedures that require prior authorizations.