Understanding Prior Authorization
As you navigate your health care, it’s important to note there are certain medical services or provider visits that require prior authorization by Dean Health Plan. The prior authorization process can take up to 14 business days from the date your primary care provider (PCP) or specialty physician submits the prior authorization request. Medically urgent authorizations, as determined by your physician, are handled as a priority. Below is a process to help you determine if you need a prior authorization.
Do I need a prior authorization?
To determine whether you need to obtain a prior authorization for a service or procedure, follow the steps below.
What type of insurance plan do I have?
Confirm your plan type by referring to your Dean Health Plan ID card.
Note: Your self-funded plan coverage may have some differences that are not outlined below. You can find a list of services that require prior authorization in your Summary Plan Document (SPD), or by contacting Customer Service. You can reach a Customer Service at the telephone number listed on your ID card or by calling 877-234-4516
Is it covered?
Keep in mind, a prior authorization can only be obtained for services that are covered under your plan benefits. For example, if acupuncture is an exclusion of your policy, a prior authorization will not change that benefit. If the services are covered under your plan, they are also still subject to any applicable cost sharing (i.e. copays, co-insurance or deductibles).