Precertification—sometimes called prior authorization—is a process that requires physicians and healthcare providers to obtain advanced approval from the Health Plan before delivering a specific service to the patient to qualify for payment coverage.
High Option members need prior approval for certain services
Before having certain types of medical care or services, you will need to get precertification. It’s important that you understand when precertification is needed to keep your benefits from being reduced.
Examples of services that require precertification include:
- Inpatient hospital admission
- Organ transplantation
- Surgery that can be considered cosmetic
- Durable medical equipment
- Genetic testing
- Inpatient residential treatment center admission
- Skilled nursing facility admission
- Outpatient radiology services, including CT/CAT, MRI, MRA, and PET scans
- Mental health and substance use disorder inpatient treatment
- Other services as outlined in the Plan brochure (see Section 3: How you get care)
How to request precertification or prior approval
At least two business days before admission or services requiring prior authorization are rendered, you, your representative, your physician, or your hospital must call UnitedHealthcare. This number is available 24 hours a day:
UnitedHealthcare: 1-866-569-2064
Consumer Driven Option members need prior approval for certain services
Before having certain types of medical care or services, you will need to get either prior approval or precertification. It’s important that you understand when prior approval or precertification are needed to keep your benefits from being reduced.
Examples of services that require precertification include:
- Inpatient hospital admission
- Organ transplantation
- Surgery that can be considered cosmetic
- Durable medical equipment
- Genetic testing
- Other services as outlined in the Plan brochure (see Section 3: How you get care)
How to request precertification or prior approval
You, your representative, your physician, or your hospital must call UnitedHealthcare at least 2 business days before admission or services requiring prior authorization are rendered:
UnitedHealthcare: 1-855-808-3003
For mental health and substance use disorder inpatient treatment, your doctor or your hospital must call UnitedHealthcare Behavioral Health Solutions at least 2 business days before admission or services requiring prior authorization. This number is available 24 hours a day:
UHC Behavioral Health Solutions: 1-855-808-3003