LA-PAF-0658 - Outpatient Prior Authorization Form Outpatient Prior Authorization Form-2025

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The toll free number is (877) 431-2273.
You can also call Member Services at 1-866-595-8133 (TTY: 711) to see if something needs Prior Authorization. We will let your provider know if the service is approved or denied. If you or your provider are not happy with the decision, you can request a second review.
All out of network services (excluding ER and family planning) require prior authorization.
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.
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