Preparing for Surgery: Access Requests and Prior Authorizations

Surgeries and procedures can be stressful. We're here to make your experience easier. 

Not sure where to access care?

Sana Care is a great place to start for advice, care navigation, and more. This may include access to high-quality, low or no-cost procedures through our trusted partners, such as Carrum Health, Texas Medical Management, MDSave, and more.

If Sana Care is not eligible in your state, our dedicated Customer Support team can help you find and compare care options by:

• Contract availability
• Quality ratings
• Distance
• Patient satisfaction
• Price
• And more — use the contact information below to request assistance.

For Surgeries or Procedures

If your provider indicates any of the following, Submit an Access Request to our Care Navigation team as soon as possible:

• Your provider will not agree to bill Sana after you've asked them
• Your provider indicates a written agreement is required to bill Sana directly (see a list at the end of this article of providers that always require an agreement)
• Your provider will not allow you to book an appointment with your insurance or threaten to cancel your appointment due to your insurance 

A procedure is typically more complex and includes care billed separately by other providers (ex, surgeon, anesthesia, facility fees, labs, etc.), so we recommend reaching out as soon as possible! We depend on the point of contact at each location to communicate effectively with us, so turnaround time may vary from 1 to 3 business weeks.

Next Steps

If your preferred provider is unwilling to bill Sana for your surgery or procedure, our Care Navigation team will:

• Contact your provider directly to see if we can resolve your access issue
• Explore trusted partners and providers that offer high-quality, low-cost care
• Reimbursement for self-pay
• If needed, our team can help you find an alternate provider

Prior Authorizations 

Some services need approval to confirm that the treatment is medically necessary. Without this pre-approval, your insurance may not cover the services. The most common services that require prior authorization are surgeries, complex imaging, and more.

• Industry-standard turnaround time for prior authorization (PA) reviews is approximately 15 days from when medical records are received by our prior authorization partner, Valenz.
• In cases that require both a PA and a Single Case Agreement for billing, we can only finalize the agreement after the PA is approved.
• Emergency services do not require PA.

Provider Resources

Your provider can verify your benefits and coverage for the procedure through Sana's provider chat at sanabenefits.com or by contacting Sana at (833) 726-2123.  

If your surgery or procedure requires prior authorization, have your provider contact Valenz, our Utilization Review Accreditation Commission (URAC) accredited partner for utilization management, at (877) 608-2200 or online. Your provider can assist with prior authorization regardless of your payment method.