Services that need prior authorization

Some medical services or provider visits require prior authorization by Dean Health Plan. This helps us manage your care and ensure your receive the care you need if it’s medically necessary. 

Here are the most common services that require prior authorization—it is not comprehensive. For specific benefit information and documented confirmation of services requiring prior authorization, contact Dean Health Plan’s Customer Care Center at 800-279-1301.

• Bariatric surgery
• Biofeedback
• Clinical trials
• Communication devices
• Dental services required to treat accidental injury to teeth
• Durable medical equipment (DME): see medical policy
• Elective hospital inpatient admissions and services
• Habilitative services
• Hearing aids (for members 19 years of age and older)
• Home health care
• Hospice care
• In-lab sleep studies
• Inpatient behavioral health and addiction services
• Inpatient rehabilitative confinement
• Certain medical injectables (e.g., Botox)
• Medical supplies (e.g., Apligraf, Dermagraft, tube
  feeding formula)

• New technologies not commonly accepted as standard of care
• Non-emergency ambulance transport
• Oral surgery - approved surgical procedures
• Certain outpatient behavioral health and addiction services (e.g., partial hospital or intensive outpatient programs)
• Certain outpatient hospital or ambulatory surgical - Surgical care at an ambulatory surgical center or a provider’s office
• Outpatient physical and occupational therapy
• Certain outpatient radiology (e.g., MRI, CT, PET scan)
• Pain management
• Select diagnostic testing (e.g., genetic testing)
• Skilled nursing facility/swing bed
• Temporomandibular disorders (TMJ)
  • Surgical services
• Transplant services – (except cornea)