Some procedures must be approved before you head to the doctor. This helps us make sure you receive:
When care is performed or prescribed by an in-network provider, he or she may obtain preauthorization for you.
If you use an out-of-network provider, he or she may call us for preauthorization on your behalf.
If you are an HMO member, your primary care physician (PCP) is the only person who can call for preauthorization. You may not refer yourself.
To check your preauthorization status, call 800.471.2242, Monday through Friday, 8:00 AM – 5:00 PM.
Note: Investigational/experimental and cosmetic procedures are not eligible for coverage under most plans. To determine if a service is investigational/experimental or cosmetic, call 800.471.2242.
About Careers Legal Nondiscrimination HIPAA Code of Conduct Web accessibility Privacy Sitemap Developers SMS terms of use Machine readable files - Transparency in Coverage
Healthcare benefit programs issued or administered by Capital Blue Cross and/or its subsidiaries, Capital Advantage Insurance Company ® , Capital Advantage Assurance Company ® and Keystone Health Plan ® Central. Independent licensees of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Communications issued by Capital Blue Cross in its capacity as administrator of programs and provider relations for all companies.
© 2024 Capital Blue Cross All Rights Reserved.