Prior Authorization

We want to make sure that you are receiving the best care possible. Therefore, in certain situations, we will require your doctor to ask for approval to perform certain activities. This is called prior authorization. If you need this approval, your doctor will get it.

Example:

When Mary visits the ear, nose and throat doctor for the first time, she pays an office copay. The ENT suggests a sinus surgery for her. Before the surgery, the ENT office must get prior approval from HAP CareSource to make sure the service is necessary and covered.

How does this work? Your doctor submits a request based on the suggested treatment. Then, you and your doctor will get a notice of approval or denial within 14 days. Your request must be approved before you get treatment or services. If you’re not approved, you may have to pay for the entire cost of your care.

If your request is denied, you have the right to know why. It can be for many reasons. You can talk to your doctor or call Member Services at 1-833-230-2053 (TTY: 711).