When is a pre-authorization required for Plan benefits?

Pre-authorizations are required for eyelid, nasal and certain breast surgeries because these procedures often fall under the cosmetic exclusion.

Pre-authorizations are also required for back surgery, bariatric surgery, gender reassignment surgery, neuro-psychological testing, organ transplants, outpatient private duty nursing and sleep studies.

Please have your Physician submit a request of the proposed procedure, including the procedure codes, along with a copy of the history and physical report, clinical notes and test results. For eyelid, nasal and breast surgeries your Physician must also include diagnostic quality preoperative photographs.  Physicians may fax their request to the Pre-Authorization department at (818) 973-4473.