What is Prior Authorization?
Why is Prior Authorization Needed?
Some services or medicines are more expensive or have higher risks than others. Prior authorization ensures members receive the most appropriate and effective care. Prior authorizations:
Keep you safe
Keep insurance plans affordable
Keep your costs down
How Does Prior Authorization Work?
1. Doctor Request
Your doctor submits a request for a service or medicine that requires prior authorization.2. AZ Blue Review
On average, we review urgent requests in less than 48 hours, and other requests within 7 days.3. Decision Letter
We will let you and your doctor know about the decision and work to find alternate treatments if the prior authorization is not approved.
Appeal Process: If you disagree with our decision, you can appeal it. The letter regarding the prior authorization decision will include details on how to file an appeal request.
Important Note: If you do not get the prior authorization you need, we may not pay for your treatment, which could mean you will have to pay the bill yourself.
We’re Working to Make Prior Authorizations Easier
Gold-Card Providers
We “gold-card” thousands of network providers with a proven track record of quality so they can order services without going through the standard prior authorization process, and members don’t have to wait for care.Removing Prior Auths for Common Services
We’ve made it easier to get important care. Nearly 400 services and procedures, like hysterectomies, no longer need prior authorization.24/7 Access to AZ Blue
Our clinical teams are standing by 24/7 to respond to urgent authorizations within 8 hours of submission.
When Do You Need a Prior Authorization?
Out-of-network care, experimental medications, pain management, and other procedures might need prior authorization.
If you have a medical procedure code, you can use our look-up tool to see if a specific treatment needs prior authorization.
