Prior authorization is necessary to ensure benefit payment.
Your provider may prescribe a health care service, treatment equipment or medication which requires review and approval. This process is called prior authorization, and the goal is to ensure you receive the most appropriate, medically necessary care.
All requests requiring a medical or clinical decision are reviewed by a licensed physician or under the supervision of one. Furthermore, only a physician may deny a request. To learn more, please consult your plan documents.
You or your provider may file an appeal if coverage is denied. To appeal a decision, call Member Services or mail a written request within 180 days from the date of the denial to: Sierra Health and Life, Member Services, P.O. Box 15645, Las Vegas, NV 89114-5645
For Applied Behavioral Analysis (ABA) therapy authorization requests, ABA providers should submit this form.