Medical management for SSM employees

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For specific information, contact member services at 877-274-4693

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 Medica. 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 applicable deductible, copayment, and/or coinsurance amounts outlined in your Summary Plan Description (SPD).

Do I need a prior authorization?

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 summary plan document (SPD), or by contacting member services. You can reach member services at the telephone number listed on your ID card or by calling 877-274-4693 (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).

Note: Services provided in the emergency room do not require prior authorization.