Services That Need Preapproval

Blue Cross Blue Shield of Michigan and Blue Care Network need to review and approve some health care services before you receive them. Those services include, but are not limited to:

Blue Cross Blue Shield of Michigan PPO plans:

  • Some radiology services, including CT, CTA, MRI, MRA, MRS, QCT bone densitometry, nuclear cardiology, PET, PET and PET/CT fusion, diagnostic CT colonography and CT abdomen and pelvis scans
  • Inpatient acute care
  • Skilled nursing care
  • Human organ transplant services
  • Inpatient mental health care including residential psychiatric admissions
  • Inpatient substance abuse treatment
  • Rehabilitation therapy
  • Applied behavioral analysis

Important information about PPO plans:

Reviews of health care services don’t guarantee payment of the claims. You'll need to be sure that your plan covers those services and that your coverage is active at the time you receive treatment.


Blue Care Network HMO plans:

  • Procedures that may be cosmetic, such as removing scars or excess tissue from your eyes or abdomen
  • Physical therapy, speech therapy and occupational therapy
  • Weight-reduction procedures
  • Bone marrow transplants
  • Infertility services
  • Breast reduction
  • Durable medical equipment
  • Services from out-of-network physicians or health care professionals
  • Procedures that may be experimental or investigational

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Questions?

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