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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 (BAM)SM 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 bcbstx.com. Select Prescription Drug Lists for Metallic Individual Plans, then choose the link for your plan type (HMO or non-HMO).
Originally published 12/16/2019; Revised 2021
How do I find out how much will be paid for an out-of-network doctor or service?
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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