My Health Plan
CareAdvantage 2021Choose a Provider
Eligibility Doctors & Specialists Where Can I Get Care? Vision Benefits Drug CoverageACE Program
Drug Costs Drug Transition Policy Coverage Determination Coverage Redetermination Medication Therapy Management Pharmacy ServicesPreventive Services Language Services Member Materials Problems and Complaints End My Membership Nondiscrimination Notice Contact CareAdvantage
Eligibility Primary Care Provider Clinics Prescriptions & Pharmacies Where Can I Get Care? Vision Benefits Language Services ACE Payments Participant Resources Problems and Complaints Contact UsMedi-Cal
Eligibility Benefits & Services Member Costs Doctors & Specialists Prescriptions & Pharmacies Where Can I Get Care? Continuity of Care Whole Child Model Problems and Complaints Member Materials Language Services Contact Us Nondiscrimination NoticeHealthWorx HMO
Find a Provider Change My PCP Tips on Choosing a PCP Types of SpecialistsView My Drug Benefits Urgent Care Complex Case Management Nurse Advice Line Language Services Health Information
Health ConditionsPrior Authorization Member Resources
Addiction and Recovery Asthma Diabetes Depression Heart Disease & Stroke HIV / AIDSAlcohol and Drugs Alternative Care Exercise Preventative Care Pregnancy Child Health Sexual Health Teen Health LGBTQ+ Health Older Adults Nutrition Weight Management Quit Smoking Self-Management Tools
Member Handbooks Find a Form / Request Records Member Newsletter News and Announcements Urgent MessagesAppoint a Representative HPSM's Ride Benefit Telemedicine File a Complaint Member Stories Contact Member Services Member Portal Login
When to Get Prior Authorization
For emergency care, you never need prior authorization (pre-approval)
Even out-of-network emergency care is covered. This includes having a baby.
The following always need pre-approval
even if you get them from an HPSM network provider.
- Hospitalization, including long term care
- Services outside of the HPSM service area
- Outpatient surgery
- Long-term therapy
- Specialized care
- Specialized radiology procedures (such as a CT scan or an MRI)
Not sure if you need pre-approval?
- Ask your primary care provider (PCP).
Your PCP's phone number is on your HPSM member ID card.
- Check HPSM's Prior Authorization Required List
Note that a treatment can have multiple procedure codes. If you do not know the procedure code(s) for the treatment you want, ask your PCP.