Understanding Prior Authorization
As you navigate your health care, it’s important to note there are certain medical services or provider visits that will require prior authorization by Dean Health Plan. Our printable process sheet will help walk you through whether you need a prior authorization. And, you can keep it for future reference.
Both urgent and emergency care are covered under your plan if you are not able to return to the Dean Health Plan service area for immediate treatment—and if the medical need is determined as such upon review. Make sure you understand the types of care available to you and download a Right Care guide or list of urgent care locations in our service area before you leave town.
Urgent care should be received at the nearest appropriate medical facility unless you can safely return to the service area. Please contact Dean Health Plan by the next business day after seeing a non-plan provider. When we receive a claim for the services, it will be reviewed to determine if the diagnosis or symptoms were urgent. If so, payment will be based on our maximum allowable fee. You will be responsible for any fees that exceed this amount.
If you are outside of the service area and require emergency care, please call 911 or go to the nearest medical facility. Please contact Dean Health Plan by the next business day after receiving any emergency treatment or an emergency admission to a non-plan facility. If you are admitted to a non-plan facility for inpatient mental health services, we must be contacted within 72 hours of being admitted. Failure to contact us could result in your being financially liable for all services.
Follow-up appointments to an urgent or emergency visit should be made with a Dean Health Plan provider. If this is not possible, please contact your home primary care provider for a prior authorization to an out-of-network /non-plan provider. Calling the Customer Care Center at (800) 279-1301 can also help you verify a provider in that area that is covered under our nationwide network.