When to get authorization
The following services always need pre-approval, even if you receive them from a provider in the HPSM network:
- Hospitalization, including long term care
- Services out of the HPSM service area
- Outpatient surgery
- Long-term therapy
- Specialized treatments
- Specialized radiology procedures such as a CT scan or an MRI
Pre-approval for Emergency Care
You never need pre-approval for emergency care, even if it is out of network. This includes having a baby.
If you are not sure whether you need prior authorization for a treatment, please talk to your primary care provider (PCP). You can find your PCP's phone number on your HPSM member I.D. card.
You can also look at HPSM's Prior Authorization Required List to determine whether the service requires prior authorization. Please note that a given treatment can have multiple procedure codes. Please talk to your provider if you do not know the procedure code for the treatment you are requesting.