Request an Authorization
Patient / Primary Care Auth Request
For some insurance policies, the auth request to see an out of network provider is required by either the patient or the patients' primary care physician. In the event this is a policy requirement, please use the link below to instruct you or your primary care physician how to properly obtain your authorization.
For Midwife, Home Birth, and Birth Center Care
If you are choosing to birth with a midwife, at home, or at a birth center, your insurance more than likely does NOT cover this service unless the midwife, or birth center is a contracted provider. The problem is MOST Arizona midwives and birth centers are non-contracted providers. Below are instructions to request in-network coverage for your out of network provider, or what in the insurance world is called a GAP exception.
For other Providers of Care
As a customer of the insurance company, you have the right to request the type of care you receive. Some providers are out of network or provide a service that is not covered by your insurance. By requesting a GAP exception, you are asking your insurance provider to allow you to receive the care as an in network benefit.
This plan requires referral / authorization from PCP to Specialist
Please provide your client/patient the attached form to provide their PCP for accurate submission. Please note, IF the patient is seen, without the referral/authorization claims will not be covered.