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Prior Authorizations

As long as you use in-network providers, you will not have to complete any prior authorizations. If you choose to see an out-of-network provider, you will be required to complete a prior authorization for medical services and drugs.

Prior Authorization for Medical Services (Organization Determination)

An organization determination is a decision made by Select Health to either approve or deny payment for services or plan coverage. You
have the right to request an organization determination if you want us to provide or pay for an item or service you believe should be
covered. In some cases, we might decide an item or service is not covered or is no longer covered by Medicare for you.

We require Prior Authorization for some services because the medical literature shows that other treatment options for certain conditions are just as effective and possibly safer.  For more information, please refer to your Evidence of Coverage and Select Health policy. To view our medical policies, click here.

To request an organization determination, choose your preferred method:

Call Member Services:

call 855-442-9900 (TTY:711)

Fax:

print  801-442-0825

Mail:

Attn: Healthy Connections
Select Health
P.O. Box 30196
Salt Lake City, UT 84130-0196

If you disagree with the determination, you can file an appeal.


Prior Authorization for Part D Prescription Drugs (Coverage Determinations)

A Part D coverage determination is any approval or denial made by Select Health about your drug benefits including:

  • Whether a particular drug is covered
  • Whether you have met all the requirements for getting the requested drug
  • How much you're required to pay for a drug
  • Whether to make an exception to a plan rule when you request it

You may ask us for an exception if you believe you need a drug that is not on our list of covered drugs or believe you should get a
nonpreferred drug at a lower out-of-pocket cost. You can also ask for an exception to cost utilization rules, such as a limit on the quantity
of a drug. If you think you need an exception, you should contact us before you try to fill your prescription at a pharmacy. Your doctor
must provide a statement to support your exception request.

If you or your doctor would like to request a coverage determination or exception, please choose your preferred method:

Fill out a form:

link  Online Coverage Determination Request Form

picture_as_pdf  Coverage Determination Request Form

Call Member Services:

call  855-442-9988 (TTY:711)

Fax:

local_printshop   801-442-0413

Mail:

Attn: Pharmacy Services
Select Health
P.O. Box 30196
Salt Lake City, UT 84130-0196

If you disagree with the our decision of your coverage determination, you can file an appeal for a Part D Redetermination using the Part D Redetermination Request Form.