Prior Authorization

The documents below list services for which Oscar may require prior authorization before Oscar will cover their costs. For additional details on Prior Authorizations, the submission process, reporting, and the list of services, please search by the member’s plan state, which can be found on the first page of the member’s Evidence of Coverage. Members can find this in their profile on the Oscar App under “Documents and Forms”.

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Get Prior Authorization Documents

Select your state, year, and language and click "Apply" to see all relevant documents.
Footnotes
Generally, in-network Health Care Providers submit prior authorization requests on behalf of their patients, although Oscar members may contact their Concierge team at  1-855-672-2755 for Oscar Plans, 1-855-672-2720 for Medicare Advantage Plans, and 1-855-672-2789 for Cigna+Oscar Plans to initiate authorization requests and can check authorization status. In-network Health Care Providers can use Oscar’s Provider Portal at https://provider.hioscar.com or call 1-855-672-2755 for Oscar Plans and 1-855-672-2789 for Cigna+Oscar Plans to confirm authorization requirements for a specific code or service, or to submit an authorization request. For services where Oscar delegates utilization review, you will be transferred to or instructed to contact the appropriate vendor.
*Cigna + Oscar coverage is insured by Cigna Health and Life Insurance Company. CA: benefits administered by Oscar Health Administrators. Other states: benefits administered by Oscar Management Corporation. Pharmacy benefits provided by Express Scripts, Inc. Cigna + Oscar health insurance contains exclusions and limitations. For complete details on product availability and coverage, please refer to your plan documents or contact a representative.