Preapproval

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

Download services and drugs that require preapproval

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.