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What You Need to Know About Prior Authorizations

November 2021

What You Need to Know About Prior Authorizations

Blue KC requires prior review for some healthcare services, procedures, and medications to ensure that you receive care that is appropriate, and necessary. It’s also a way for us to keep healthcare costs down. Prior authorization is usually required if you need a complex treatment or prescription.

It’s up to your doctor to start the prior authorization process, and they will communicate with Blue KC’s Prior Authorization Department who will review your doctor’s recommendation and then either approve or deny the request. This decision will be made by medical doctors and clinical pharmacists at Blue KC who’ve been trained in reviewing prior authorizations.

Blue KC constantly updates the clinical guidelines and medical policies we use so that we can make consistent, fair, and ethical decisions based on the latest medical research and literature.

Are you wondering what you as a patient can do when most of the action items involving prior authorizations fall on your provider and insurance company? You can do your part by knowing what procedures, products, services, and medications require prior authorization, and confirming your provider has the correct information to submit on your behalf.

To learn what procedures require prior authorization, visit You can also refer to your Medical Benefits Booklet.

If you have any questions, contact our Prior Authorization Depart at 816-395-3989 or 1-800-892-6116. Or call the Blue KC Customer Service number on your member ID Card.

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