Make sure you're covered.

LifeWise offers many services and procedures that require preapproval. This process determines whether or not a service is eligible for coverage under your plan. Your in-network provider, who uses the term “prior authorization,” can request preapproval on your behalf.

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Preapprovals help you:

  • Make sure you're covered by your benefits before you have any scheduled procedure
  • Save money and avoid extra costs
  • Get an estimate of your out-of-pocket costs
  • Avoid inappropriate or unnecessary medical treatment and services

LifeWise uses a team of experienced doctors, nurses, and healthcare analysts to determine if a medical procedure is appropriate and supported by clinical best practices.

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Services that require prior authorization*

  • Planned admission into hospitals or skilled nursing facilities
  • Some inpatient surgeries
  • Nonemergency ground or air ambulance transport
  • Advanced imaging, such as MRIs, CT scans, and cardiac imaging
  • Transplant and donor services
  • Some planned outpatient procedures and surgeries
  • Some injectable medications you get in a healthcare provider's office
  • Prosthetics and orthotics other than foot orthotics or orthopedic shoes
  • Reconstructive surgery
  • Some home medical equipment
  • Some drug treatments

Common questions

What services do not require preapprovals?

  • Hospital admission for childbirth and newborn care
  • Emergency admission to hospital
  • Office visits to a primary care doctor, family doctor, or specialist

Can doctors in the LifeWise network request preapprovals for me?

They are familiar with the process and have all of the information needed to contact LifeWise and request that your medical service be reviewed and approved for coverage. If your provider hasn’t already told you that the procedure is approved, be sure to ask before scheduling it.

What if my doctor doesn't request a preapproval?

If your doctor provides a service that requires prior authorization and has not requested it, you may have to pay part or all of the cost, above your usual cost shares. For complete information about your plan's medical benefits and prior authorization requirements, check your benefit booklet.

What about pharmacy and drug preapprovals?

If you have a prescription plan benefit, some drugs must be approved for coverage through our pharmacy preapproval program as drugs requiring approval.


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