Plan Options

• MedicareBlue PPO
  • 2008 Benefits at a Glance (PDF)
  • 2008 Enrollment Guide (PDF)
  • 2008 Summary of Benefits (PDF)
  • 2008 Evidence of Coverage
  • Prior Authorization
  • Quantity Limits
  • Questions & Answers
  • Complaints & Appeals (PDF)
  • Request Information
  • Enroll Now
• MedicareBlue Rx
  • 2008 Benefits at a Glance (PDF)
  • 2008 Enrollment Guide (PDF)
  • 2008 Summary of Benefits (PDF)
  • 2008 Evidence of Coverage
  • Pharmacy Benefit Manager
  • Complaints & Appeals (PDF)
  • Questions & Answers
  • Request Information
  • Prior Authorization
  • Quantity Limits
  • Step Therapy
  • Enroll Now
• Medicare Supplement Plans & Other Options
• Group Plans

MedicareBlue PPO

Prior Authorization

Some of the in-network covered services listed in the Benefits Chart are services for which your provider should obtain “prior authorization” (approval in advance) from MedicareBlue PPO. You can find a list of those services here. This list is subject to change. Please call MedicareBlue PPO Customer Service to obtain the most current prior authorization list.

When you use plan providers, the provider will usually initiate the prior authorization process on your behalf. If you choose non-plan providers, and you want to know whether the services will be covered before you receive them, you are responsible for working with your provider or calling Customer Service to make sure that the services you receive will be covered and considered medically necessary.

The prior authorization process lets you know in advance if a service or supply is covered by MedicareBlue PPO. If prior authorization is not obtained for the services on the prior authorization list, MedicareBlue PPO will not cover the service, unless MedicareBlue PPO later determines that the services were medically necessary. To request a prior authorization, call MedicareBlue PPO Customer Service at 1-888-457-3009 (TTY/TDD 1-888-457-3005), 8:00 a.m. to 8:00 p.m. daily, Central and Mountain Time.

Prior Authorization for Drugs

Prior authorization is required for certain covered drugs that have been approved by the Food and Drug Administration (FDA) for specific medical conditions.

A prior authorization request form must be completed for all medications requiring prior authorization. Following are the prior authorization program guidelines:

• The prescribing physician should notify MedicareBlue PPO in advance about the medical condition that requires the use of drugs that appear on the prior authorization list; getting the authorization in advance prevents delays at the pharmacy.
• Contact Customer Service for MedicareBlue PPO:
• Toll Free 1-888-457-3009
  TTY/TDD users should call 1-888-457-3005
  8:00 a.m. to 8:00 p.m., daily, Central and Mountain Time
• Once the drug is authorized, it can be filled at any participating pharmacy
• For most drugs, the authorization is valid for one year

You may search the drug formulary now to find out if your drug requires prior authorization.