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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 current federal 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 Cigna/CareAllies. This includes mental health and substance use disorder inpatient treatment. This number is available 24 hours a day.