To request prior authorization, you or your provider can call Summit Health Customer Service at 844-827-2355. They can also fax our prior authorization request form to 855-466-7208.
When we say you need to get prior authorization for a service or prescription drug, it means that you need to get pre-approval from us to cover it. Prior authorization is also referred to as organization determination or coverage determination. Prior authorization is required for:
If you need a prescription drug that is not in our formulary, you or your provider can request that we cover it.
To request an exception, you or your provider may do one of the following:
You can request a review of a medical or pharmacy decision we have made. You can also file a complaint to Medicare.
Last updated Dec. 17, 2020