Prior Authorization

There may be a time when you have a health problem that your primary care physician (PCP) can’t treat alone. Sometimes you may need to see a specialist.

Prior authorization is a request to Aetna Better Health℠ Premier Plan for you to get special services. We must approve your provider’s request before you can receive these services.

As a reminder, you don’t need a referral or prior authorization to get emergency services.

View a list of services that require prior authorization. 

Prior authorization form.

How it works
Aetna Better Health Premier Plan providers follow prior authorization guidelines. If you need help understanding any of these guidelines, just call Member Services. Or, you can ask your case manager.

It may take up to 14 days to review a routine request. We take less than or up to 72 hours to review urgent requests. All reviews are timed from when we first receive the request.

If we need more information, we may ask for a 14-day extension. If we don’t get the information we need, we may deny the request. If this happens, you’ll receive a Notice of Denial letter that explains your appeal rights. 

If your provider makes an urgent prior authorization request and it doesn’t meet the urgent criteria, we’ll send you a letter to let you know it will be processed as a routine request. You can make a complaint if you disagree.

Questions about your prior authorizations? Just call your PCP, your case manager or Member Services.