PT, OT and chiropractic prior authorizations not required for fully insured group members and members with individual coverage

In January, Blue Cross Blue Shield of Michigan began requiring prior authorization for lumbar spine fusion, radiation oncology and interventional pain management services provided to our fully insured group members and members with individual coverage. We also planned to require them to seek prior authorizations for physical therapy, occupational therapy and chiropractic services starting July 1.

However, we’ve decided that prior authorization for PT, OT and chiropractic services won’t be required for our fully insured group members and members with individual coverage at this time.

Keep in mind that prior authorization programs are commonly used for certain services (such as complex surgeries, diagnostic imaging and specialty drugs) and help to ensure quality care that aligns with our members’ benefits. These programs also let health care providers and members know in advance whether a service will be covered. Prior authorization programs are used by many health care plans across the country.

This change doesn’t affect prior authorization programs that are currently in place for other members, such as those with Medicare Plus Blue^SM, Blue Care Network or BCN Advantage^SM.