Pre-authorization being added for specific cardiac services on fully insured plans beginning Jan. 1, 2023

November 15, 2022

Beginning Jan. 1, 2023, we’re adding a pre-authorization (PA) requirement to coverage of specific cardiac procedures for employees on fully insured plans. This change will help ensure providers follow the standard of care for the specific service and avoid unnecessary and potentially more invasive procedures and their associated costs.

In addition, the PA requirement supports our commitment to improving the clinical appropriateness of cardiac services delivered to employees. The burden of PA lies with the provider and, if the provider is in network, they cannot balance bill employees. We anticipate this change will be transparent to employees.

Questions? Contact your account representative.