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Some services may need preapproval (an OK) from us before you get them. Your primary care provider (PCP) will ask for the preapproval for you. That’s part of why it’s important to see your PCP first for health issues that aren’t emergencies and for annual well-visits.

Preapproval is needed for these services

  • Seeing a doctor outside your plan, unless it’s an emergency
  • Some mental health and substance abuse services
  • Some ambulance transportation
  • Inpatient hospital admissions
  • Outpatient surgeries
  • Certain outpatient procedures and tests
  • Nonemergency surgeries
  • Therapy services

You don’t need preapproval for these services

  • Urgent care
  • Emergency care
  • Family planning

Have questions?

Call Member Services at 1-855-690-7800 (TTY 711) from 8 a.m. to 5 p.m. local time for more information about preapprovals or to check on the status of a preapproval request.