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This article is intended for members enrolled in an individual health insurance plan.
Here are examples of when and why your doctor may check in with us.
Your doctor may check with us before your appointment to confirm:
Your doctor may check with us before certain tests or other procedures to confirm:
Your doctor may check with us before prescribing some medicines to confirm:
Prior authorization helps make sure you get the care you need with as little out-of-pocket cost as possible.
Not all procedures or drugs require prior authorization. For a more complete list of procedures that do require it, check your benefit information. Log in to your Blue Access for MembersSM account. Select the My Coverage tab and click on the prior authorization link under My Coverage Benefits. Next, click Referral and Prior Authorization Information.
To check your drug list, see Prescription Drug Lists at bcbsnm.com. Select Prescription Drug Lists for Metallic Individual Plans, then choose the link for your plan (5-tier or 6-tier drug list).
Originally published 12/16/2019; Revised 2021, 2022, 2023
Medically necessary ? I don’t know how this happened that an insurance company has more power than my doctor regarding my treatment! Prior Authorization is a joke. It’s a way for you to delay or stop my treatment. I have been on my migraine medication for four years and honestly it’s the only reason I am still alive. Why would you deny a medication that is ON your formulary and instead, insist I take an antidepressant or anti-seizure medication instead of my migraine medication? Your response: you don’t have more than 15 migraines a month, do you think maybe it was because I was on my medication? It is far less expensive to have me on my meds than to continually go to the ER, where I would hit my deductible pretty fast then you have to cover everything for the rest of the year? It’s not like you are paying for my medication because of the savings card! Insurance in this country needs to change. Only my doctor should be in charge of my treatment. Stop playing with my life!
Ann - please send us a private msg with your info & we will review your plan to determine if you are covered. HeatherA
can someone tell me if I am covered while traveling abroad for a covid emergency?
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