Medical management

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For Medica employees

For specific information, contact WellFirst Health Customer Care Center at 833-942-2159

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 WellFirst Health. When we receive a prior authorization request from your plan provider, we typically decide on requests for prior authorization for medical services within 72 hours of receiving an urgent request or within 15 calendar days for non-urgent requests. 

Remember, even with an approved prior authorization, not all services are covered at 100%. You will be responsible for the co-pays and deductibles outlined in your Summary Plan Description (SPD). Below is a process to help you determine if you need a prior authorization.

Do I need a prior authorization?

Services provided in the emergency room do not require prior authorization. To determine whether you need to obtain a prior authorization for a service or procedure, follow these steps. 

Determine what type of insurance plan you have

Confirm your plan type by referring to your member 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 SPD, or by contacting Customer Service. You can reach Customer Service at the telephone number listed on your ID card or by calling 833-942-2159 (TTY: 711).

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).