Prior authorization: What you need to know

When you get approval for tests, procedures and more, it helps Allina Health | Aetna make sure that you get care backed by the latest medical evidence. Learn more about the prior authorization process.

Some medical procedures, tests and prescriptions need prior authorization, which is sometimes called preapproval or precertification. This helps us make sure that your health care services are appropriate for your personal medical needs.

Here's how the prior authorization process works:

1. Visit your doctor

To get prior authorization, your doctor must first submit a request for a specific procedure, test or prescription. They will look at your overall health or any chronic conditions to make that decision. Then they’ll share the request with Allina Health I Aetna.

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Call our 24/7 Nurse Line at 1-855-493-7019 (TTY: 711) to speak with a nurse, 24 hours a day, 7 days a week. If it’s an emergency, dial 911.

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2. Check in with your doctor about the status of the requested prior authorizations

Once your doctor sends a request for prior authorization, Allina Health I Aetna reviews the request. During our review, we look at the most recent and highest quality medical research and guidelines. We update your care provider throughout the review process to keep them informed on the status, and come to a decision within 14 days. Your doctor can keep you updated on the status of your requested prior authorizations.

Need to find an in-network provider?

Visit AllinaHealthAetnaMedicare.com/FindProvider or call Member Services at 1-833-570-6671 (TTY: 711) between 8 AM and 8 PM, 7 days a week.

Question of the month

"What do I need to get prior authorization for?”

Each Allina Health I Aetna plan has its own different rules on whether a referral or prior authorization is needed. To be sure, check Chapters 3 and 4 of your Evidence of Coverage (EOC) to see your plan’s rules for prior authorization.

Look for this note in your EOC: “Prior authorization may be required and is the responsibility of your provider.” You also need prior authorization for care that isn’t available through Allina Health I Aetna in-network providers.

Procedures, surgeries, supplies, medications and care that may require prior authorization include:

Hip and knee replacements
Radiology or imaging services
Cardiac catheterizations and rhythm implants, to help your doctor assess your heart health
Pain management
Sleep studies
Transplants
Kidney dialysis
Diabetic shoes and inserts
Physical therapy, occupational therapy and speech therapy
Home health aide services
Medical equipment and supplies
Some inpatient hospital care

For more help understanding what you need prior authorization for, call the Member Services number on your member ID card, 1-833-570-6671 (TTY: 711). We’re available between 8 AM and 8 PM, 7 days a week.

Happy with your Allina Health I Aetna Medicare plan?

If so, consider referring a friend or family member. They can call us at 1-800-361-2511 (TTY: 711) to see if they are eligible to enroll and to learn more about our plans. A licensed agent will answer their call.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.  Participating health care providers are independent contractors and are neither agents nor employees of Allina Health I Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.