Blue Cross Blue Shield Vermont: Catamount Prior Approval

Catamount BlueSM Prior Approval

BCBSVT requires Prior Approval for the Services listed below. If you do not get approval in advance, your care will not be Covered. Obtaining Prior Approval for these Services ensures that they are diagnostically appropriate, medically necessary and cost-effective. In the event of an emergency, Prior Approval is not required. However, we request that you contact us as soon as reasonably possible.

Mental health or Substance Abuse treatment
Plastic or cosmetic procedures (for example, abdominoplasty, lipectomy, blepharoplasty, breast reconstruction, otoplasty, panniculectomy, rhinoplasty or septorhinoplasty)
Certain Surgery (bariatric surgery, gastric electrical stimulation, percutaneous vertebroplasty or vertebral augmentation)
Dental Services (oral surgery, trauma, orthognathic surgery)
Chiropractic care after initial 12 visits in a calendar year
Cardiac MRI or MRI of the pelvis/uterus, of upper or lower extremity other than joint, of the abdomen or of the breast
MRA of upper or lower extremity
All MRS and PET scans
UPPP/somnoplasty
Continuous passive motion (CPM) equipment
Durable medical equipment (DME) with a charged amount over $1,000, including CPAP/BIPAP, vacuum-assisted closure of chronic wounds and electric breast pumps (for members not enrolled in Better Beginnings®)
Orthotics/prosthetics
Polysomnography (sleep studies) and MSLT
Chondrocyte transplants
Osteochondral Autograft Transfer System
Continuous glucose monitoring
Home infusion therapy
Private duty nursing
Transplants (except kidney and cornea)
TENS units/neuromuscular stimulators
Rehabilitation (cardiac, pulmonary or inpatient rehabilitation facility)
Certain prescription drugs
Non-emergency ambulance transport, including air or water ambulance transport
Capsule endoscopy
Medical nutrition for inherited metabolic disease
New procedures still considered investigational or experimental

How to Request Prior Approval

To get Prior Approval, you or your physician must send a letter with supporting documentation to BCBSVT. Our Approval Request Form can help you make your request.

Prior Approval Request Form for Medical Services

Prior Approval Request Form for DME, Orthotics, and Prosthetics

Prior Approval for Prescription Drugs

Your provider may also help you fill out the form and give you other information you need to submit your request. The medical staff at BCBSVT will review the information and respond in writing to you and to your doctor.

We do not allow benefits for Services that require Prior Approval if you do not get Prior Approval. If you don't seek Prior Approval or we deny approval, you will have to pay the full cost of your care.