If you ever need hospitalization, your Blue Network plan offers a wide range of hospitals to choose from. But no matter which hospital you select, you must get advance approval - or prior authorization - from BlueCross before you begin your hospital stay.

Prior authorization helps you get the most for your health care dollar. Registered nurses work with physicians to check and monitor medical services to help assure you receive the most appropriate and cost-effective care for your condition. Only a physician can deny a prior authorization.

Services that need prior authorization

Make sure you get prior authorization before you're admitted to a:

• Hospital
• Skilled nursing facility
• Rehabilitation facility

Or before you begin:

• A 23-hour observation stay
• Home health services
• Home infusion therapy
• Certain outpatient services

If you do not receive prior authorization for these services, you will often have to pay all or a larger share of the costs.

Remember, it's your responsibility to get prior authorization before receiving these listed services from a provider that's not in your network. To get your prior authorization review started, call the number listed on the back of your BlueCross BlueShield of Tennessee ID card.

Question high-cost, high-tech imaging services

Certain high-cost, high-tech imaging services are being used more and more to diagnose conditions that a simple X-ray or other low-cost, low-tech medical tool can diagnose very effectively. Overuse of high-tech imaging is making health care less affordable.  Experts agree that these tests many times add little or no information to improve a patient's diagnosis or treatment. If your doctor recommends high-tech imaging, ask how the results of the scan will affect your care.

As a quality check to be sure the right imaging tool is used for your condition, your plan may also require your doctor to get a prior authorization for your outpatient high-tech imaging services.

Prior authorization may be required for:

• magnetic resonance imaging (MRI),
• magnetic resonance angiography (MRA),
• magnetic resonance spectroscopy (MRS),
• computed tomography (CT scans),
• computed tomography angiography (CTA scans),
• positron emission tomography (PET scans), and nuclear cardiology.

High-tech imaging services done in the emergency room or as an inpatient do not require authorization.