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  • You can find out if you need prior authorization for a specific service or treatment by signing in and following these steps:

    1. Click Benefits & Coverage.
    2. Click What’s Covered.
    3. Select the correct tab - Medical, Dental, Prescription, as appropriate.
    4. From the dropdown menu marked Service you may need, select the service you want to check and click Show Coverage Details.
    5. Check the chart(s) to see if prior authorization is required. It will say Yes or No under the column heading Prior Authorization. You may need to scroll down to view all the information you need.

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    Last updated:

    Oct 26,2021

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  • Prior authorization is the written approval from Horizon, prior to the date of service, for a doctor or other health care professional or facility to provide specific services or supplies. It is sometimes called pre-authorization, prior approval or pre-certification. Your Horizon plan may require prior authorization for certain services before you receive them, except in an emergency. Prior authorization isn’t a promise your health insurance or plan will cover the cost. Your participating doctor will work with Horizon to obtain prior authorization.

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    Last updated:

    Jan 11,2022

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  • Some in-network medical services are only covered if your doctor or other network provider gets approval in advance. Your primary care physician or specialist may obtain prior authorization for you by calling 1-800-664-2583 (TTY 711).

    You can sign in to see what services require prior authorization.

    Approval is not a guarantee of payment. The benefits of your policy at the time of service are still applied, including in-network vs. out-of-network benefits, exclusions, limitations, copayments, deductibles and/or coinsurance. A service or treatment may be medically necessary but not covered under your specific health benefits plan.

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    Last updated:

    Jan 11,2022

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  • Sign in to view the status of prior authorizations that your doctor or other health care professional has submitted.

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    Last updated:

    Jan 11,2022

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  • Sign in to view the status of referrals that your doctor or other health care professional has submitted.

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    Last updated:

    Jan 11,2022

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  • Some plans require you to get a referral from your Primary Care Physician before you see a specialist. Sign in to see if your plan requires referrals.

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    Last updated:

    Jan 12,2022

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