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Atención médica

Autorización previa

A woman shaking hands with a doctor in a sunny waiting room.

¿Qué es una autorización previa?

Sometimes, you may need to get approval from Blue Cross and Blue Shield of Oklahoma before we cover certain health care services and prescription drugs. 

This is called prior authorization, sometimes called prior authorization,  preauthorization, pre-certification or prior approval. 

When prior authorization is needed, we, along with outside vendors1, review the requested service or drug to find out if it’s medically necessary and appropriate for your needs. Esta revisión no reemplaza el asesoramiento del profesional médico que le atiende.

Recursos

How Do You Know If You Need Prior Authorization?

If you're fully insured1, use our digital lookup tool:

Our digital lookup tool helps you search for medical procedures, prescription drugs and behavioral health services that may require prior authorization.

Ícono de estetoscopio

Procedimientos médicos

Medical procedures like some surgeries, transplants, imaging and other tests often require prior authorization.

Buscar procedimientos médicos

Ícono de frasco de medicamentos.

Medical or Prescription Drugs

Search medical drugs, like your prescriptions or specialty prescriptions, that may require prior authorization.

Buscar medicamentos

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Servicios de salud mental

Prior authorzation may be required for some behavioral services like psychological testing or psychiatric care.

Search behavioral health care

Review BCBSOK's Prior Authorization Code Lists

Para buscar la lista completa de servicios y medicamentos que requieren autorización previa, haga clic a continuación para descargar una copia de la hoja de cálculo. Except as otherwise noted, these prior authorization requirements are effective as of Jan. 1, 2025:

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Requesting Prior Authorization

We Make Requesting Simple

Most of the time, your doctor will take care of prior authorization before offering care. But, it’s always a good idea to check, especially if your doctor's not in network. If you use an out-of-network doctor, you may need to handle prior authorization. Start by calling the number on your member ID card.  

When you call, we'll need the following information:

  • Su nombre, el número de asegurado principal y su fecha de nacimiento
  • El nombre del profesional médico que le atiende, la dirección del mismo y su número de identificación nacional para profesionales médicos (NPI)
  • Información sobre su enfermedad o afección de salud mental
  • Your provider's proposed treatment plan, including any diagnostic or procedure codes
  • When you'll get care and, if you're being admitted, an estimated length of stay
  • Where you’re being treated

Search In-Network Care

Not Sure If Your Doctor's In Your Network?

Log in to your member account and use our Provider Finder® tool to search for in-network doctors, hospitals and providers.

Log In to Search

1 Carelon Medical Benefits Management (Carelon) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSOK.

eviCore® es una marca registrada de eviCore healthcare, LLC, anteriormente conocida como CareCore, una compañía independiente que ofrece revisión de utilización para ciertos servicios de atención médica en nombre de Blue Cross and Blue Shield of Oklahoma.

2 Not sure if you’re fully insured? Hable con el departamento de Recursos Humanos o con su asesor de beneficios. Si no tiene este tipo de póliza, consulte su certificado de beneficios y servicios médicos para ver la lista de servicios que requieren autorización previa. Si tiene más preguntas, llame al número del Servicio al Cliente que figura en su tarjeta de asegurado de BCBSOK.