Prior Authorization

There may be a time when you have a health problem that can’t be treated by your primary care physician (PCP) alone. Sometimes you may need specialty care or to see a specialist.
Prior authorization is a request to Aetna for you to get special services or see a specialist.  Your clinical team or PCP requests prior authorization before the service is rendered.

You do not need a referral or prior authorization to get emergency services.

How it works
Aetna providers follow prior authorization guidelines. If you need help understanding any of these guidelines, please call Member Services at 1-855-463-0933 (TTY: 711), 8 AM to 8 PM, seven days a week.

Instructions for Accessing Aetna Supplemental Criteria Guidelines (PDF)

Aetna Clinical Policy Bulletin

Medicare Part B Drug Requirements/Guidelines

Important information for members  who need specialty services
Some outpatient services and planned hospital admissions need prior authorization before the service can be covered. Please see the Evidence of Coverage for more information about what requires prior authorization.