Services That Need Prior Authorization

Office visits to a behavioral health provider, such as a psychologist, a clinical social worker or a professional counselor, do not require prior authorization unless they are one of the services listed below. These services must be approved through prior authorization by Companion Benefit Alternatives:

• Inpatient hospital care;
• Intensive outpatient hospital care;
• Partial hospitalization care;
• Outpatient electroconvulsive therapy – hospital and physician services;
• Repetitive transcranial magnetic therapy;
• Applied behavior analysis therapy; and
• Psychological/neuropsychological testing.

To request prior authorization services, your provider must call Companion Benefit Alternatives at 800.868.1032 before you are admitted or, in an emergency situation, within 48 hours or the next working day. For professional services listed above, your provider must call before services are rendered.

Although your provider may contact Companion Benefit Alternatives for you, it is your responsibility to see that the call is made and the prior authorization has been granted. A determination by Companion Benefit Alternatives does not guarantee payment. Other conditions, including eligibility requirements, other limitations and exclusions, payment of deductibles and other provisions of the plan must be satisfied before BlueCross makes payment.

Penalties for Not Calling for Needed Behavioral Health Service Prior Authorizations

If behavioral health outpatient services that require prior authorization are not approved through prior authorization, they will not be covered.

Penalties for Not Calling for Needed Facility Service Prior Authorizations

If your provider does not call Companion Benefit Alternatives when required, you will pay a $490 penalty for each hospital admission.

Companion Benefit Alternatives (CBA) is an independent company that manages behavioral health benefits for the State Health Plan.