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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 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 that:
Your doctor may check with us before prescribing some medicines:
Pre-authorizations like these help us make sure you get the care you need with as little out-of-pocket cost to you as possible.
Not all procedures or drugs require pre-service reviews. For a more complete list of procedures that do require pre-service review, check your benefit information by logging in to your Blue Access for MembersSM (BAM)SM account. Select the My Coverage tab and click on the prior authorization link under My Coverage Benefits, then click Referral and Prior Authorization Information.
To check your drug list, see Prescription Drug Lists at bcbstx.com. Select Prescription Drug Lists for Metallic Individual Plans and then select the link for your type of plan (HMO or non-HMO).
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