Plan Options

MedicareBlue PPO (Regional 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 (Regional PPO). You can find a list of those services here. This list is subject to change. Please call 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 (Regional PPO). If prior authorization is not obtained for the services on the prior authorization list, the plan will not cover the service, unless MedicareBlue PPO later determines that the services were medically necessary. To request a prior authorization, call MedicareBlue PPO (Regional PPO) Customer Service at 1-888-457-3009 (TTY 1-888-457-3005), 8 a.m. to 8 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 (Regional 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 (Regional PPO):
Toll free 1-888-457-3009
TTY users call 1-888-457-3005
8 a.m. to 8 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.

September 06, 2010

Important Information

This page last updated and accepted by CMS July, 2010.

MedicareBlue Rx (PDP) is a Medicare-approved Part D sponsor. MedicareBlue PPO (Regional PPO) is a Medicare-approved regional PPO plan.

Coverage is available to residents of the service area or members of an employer or union group and separately issued by one of the following plans: Wellmark Blue Cross and Blue Shield of Iowa,* Blue Cross and Blue Shield of Minnesota,* Blue Cross and Blue Shield of Montana,* Blue Cross and Blue Shield of Nebraska,* Blue Cross Blue Shield of North Dakota,* Wellmark Blue Cross and Blue Shield of South Dakota,* and Blue Cross Blue Shield of Wyoming.*

*Independent licensees of the Blue Cross and Blue Shield Association.