Preauthorization

PacificSource requires written preauthorization for coverage of certain medical services, surgical procedures, and prescription drugs. The term “preauthorization” simply refers to a process by which an insurer determines in advance whether or not a specific service or drug will be reimbursed.

How It Works

Your medical provider can request preauthorization from our Health Services Department by fax, mail, or email. If your provider will not request preauthorization for you, you may contact us yourself and we will assist in facilitating the process. In some cases, we may ask for more information or require a second opinion before authorizing coverage.

A preauthorization does not imply that the entire cost of the service will be covered. Your plan’s deductible, coinsurance, and copays will still apply.

Why preauthorization is necessary

Preauthorization is necessary to determine if certain services and supplies are covered under this plan, and if you meet the plan’s eligibility requirements.

What to do if your treatment is not preauthorized

If your treatment is not preauthorized, you can still seek treatment, but you will be held responsible for the expense if it is not medically necessary or is not covered by your plan. Any time you are unsure if an expense will be covered or have any questions about your benefits, we encourage you to contact our Customer Service Department.

View Our Preauthorization Lists

As we continually review new technologies and standards of medical practice, these lists are subject to revision. Also keep in mind that your plan may not cover all the items listed. Check your benefit materials or contact our Customer Service Department if you have any questions about your plan benefits.

Medical services that require preauthorization

Medical Drug and Diabetic Supply Formulary

PacificSource Drug List includes prescription drugs that require preauthorization

PacificSource pharmacy coverage policies:  

 

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Last updated 11/4/2016