Prior authorization

Some health care services need to be approved

Aetna Better Health must pre-approve some services before you can get them. We call this prior authorization. This means that your providers must get permission from us to provide certain services. They know how to do this. We’ll work together to make sure the service is what you need.

Except for family planning and emergency care, all out-of-network services require pre-approval. You may have to pay for your services if you don’t get pre-approval for services that:

  • Are given by an out-of-network provider
  • Require pre-approval
  • Are not covered by Aetna Better Health of Louisiana

All services by providers that are not in our network need pre-approval.

The following are the steps for pre-approval:

  1. Your provider gives Aetna Better Health of Louisiana information about the services he or she thinks you need.
  2. Aetna Better Health of Louisiana reviews the information.
  3. If your provider does not think we should approve the request, a different Aetna Better Health of Louisiana provider will review the information.
  4. You and your provider will get a letter once we have approved or denied a service.
  5. If we deny your request, we will explain our reasons in the letter.
  6. If we deny a service, you or your provider, with your written permission, can file an appeal.