What type of services may require prior authorization in Anthem Medicare Advantage plans?

The requirement for prior authorization in Anthem Medicare Advantage plans often applies to specific types of services that are more complex or costly. Non-emergency surgeries and advanced imaging services typically fall into this category because they can involve significant medical intervention, resources, or expenses. Prior authorization helps ensure that the proposed treatment is medically necessary and appropriate for the patient's condition, which can help manage healthcare costs and ensure that patients receive effective care.

In contrast, routine check-ups do not usually require prior authorization, as they are considered standard preventive care. Emergency room visits generally do not require prior authorization either, given that they involve urgent medical situations where immediate care is essential. Prescription medications may require prior authorization in certain cases but not universally, as many common medications are obtained without additional approvals. Thus, the requirement for prior authorization primarily targets specific procedures and treatments, making the identification of non-emergency surgeries and advanced imaging services accurate in this context.