Prior Approval Program
Importance of Prior Approval
Certain services, supplies, and prescription drugs require advance (prior) approval before benefits are provided. This ensures the services are diagnostically appropriate, medically necessary, and cost effective.
Prior Approval Requirements
NEW for 2016! We've combined the prior approval lists for members of BCBSVT, TVHP, New England Health Plan, State of Vermont and University of Vermont Medical Center into two lists (as noted in the table below).
- BCBSVT network providers get prior approval for you. If the Vermont network provider fails to get prior approval for services that require it, the provider may not bill you.
- If you use an out-of-network provider or out-of-state provider, it's your responsibility to get prior approval. Failure to get prior approval could lead to denial of benefits. If you can show that the services you received were medically necessary, we will provide benefits.
Requesting Prior Approval
- BCBSVT network providers must send appropriate documentation to BCBSVT.
- When receiving care from a non-network provider or an out-of-state provider, you must complete the appropriate form; you may also get the form by calling our customer service team.
- The BCBSVT medical staff will review the information and respond in writing to you and your provider.
Check Prior Approval Status
To check prior approval status, call customer service at (800) 247-2583.