Many times, your doctor will need to get preapproval, otherwise known as preauthorization, before your UT CARE plan with Blue Cross and Blue Shield of Texas will cover certain health care services and prescription drugs. This is how we help ensure you get the right care, at the right place, at the right time.

Preauthorization verifies in advance (or within 48 hours of an emergency hospital admission) the medical necessity of certain care and services covered under UT CARE.

Preauthorizations are your provider’s responsibility. Your health care provider will submit a request before ordering a test or medication. Preauthorization is needed for:

• Inpatient hospital admissions
• Skilled nursing care in a skilled nursing facility
• Home health care
• Hospice care
• Home-infusion therapy
• Motorized and customized wheelchairs
• Certain durable medical equipment over $5,000
• Transplants
• Inpatient treatment for mental health, mental illness and chemical dependency

Preauthorization is also required any time you or your doctor want to:

• Extend your hospital stay beyond the days initially approved
• Transfer you to another facility or a specialty unit within the facility

Always secure preauthorization for:

• Advanced imaging procedures (CT, MRI, PET scans)
• Sleep studies and related medical equipment/supplies
• Pain management procedures
• Joint and spine surgery
• Cardiology procedures

Keep in mind, some additional outpatient procedures may also require provider preauthorization.

If you have any questions about your benefits, call the number on the back of your member ID card.