Prior Approval Program

Importance of Prior Approval

BCBSVT provides benefits for certain services, drugs and supplies only if you get approval in advance.

• Obtaining prior approval for these services ensures that the procedures are diagnostically appropriate, medically necessary and cost effective. 
• If prior approval is denied or not sought you (the member) must cover the full cost of care.

Services Requiring Prior Approval

• Refer to the current list of services which require Prior Approval

Who's responsible?

• Members are responsible (and liable) for obtaining prior approval before receiving services
• Providers typically submit the necessary documentation for prior approval but it is the responsibility of the member to make sure it's obtained
• To check prior approval status, call customer service:
  • 1-800-247-2583 (non Catamount Blue^sm members)
  • 1-888-445-5805 (Catamount Blue^sm)

To get Prior Approval: 

• Your physician must send appropriate documentation to BCBSVT.
• The medical staff at BCBSVT will review the information and respond in writing to you and to your doctor.