What is prior authorization?
Prior authorization means that Blue Cross and Blue Shield of Florida must authorize coverage for certain medical services, medical supplies and prescription drugs before they will be covered under your medical or prescription drug plan. Note: This requirement varies by plan. For details, please refer to your benefit booklet and pharmacy endorsement, if applicable.
Is a prior authorization required in an emergency situation?
No. If you are taken to an emergency room in an emergency situation, you do not need a prior authorization. Note: An emergency is an instance in which the absence of medical attention could jeopardize a person’s life, health, or ability to regain maximum function, or could subject a person to severe pain.
Is a prior authorization needed if I go to an out-of-network or out-of-Florida doctor or hospital?
If your doctor or hospital is NOT a Blue Cross and Blue Shield of Florida participating network provider or is located outside of Florida and the service which you are seeking requires a prior authorization, then it’s your responsibility to ensure the provider obtains a prior authorization for you. It’s easy to initiate: Simply have your non-network or out-of-Florida doctor or hospital call the number on the back of your ID card. If a prior authorization is not obtained, you may be responsible for the entire cost.
Exception: In an emergency situation, a prior authorization is NOT required. An emergency is an instance in which the absence of medical attention could jeopardize a person’s life, health, or ability to regain maximum function, or could subject a person to severe pain.
