- Upon completing the SelectHealth prior authorization form, the physician can fax or mail it to SelectHealth so that the insurance company can determine whether to sanction this request.
- Form can be faxed to: 1 (866) 610-2775
- Physicians should include as much information concerning their diagnoses and medical reasoning as possible to establish a sound argument.
SelectHealth Prior (Rx) Authorization Form
A SelectHealth prior authorization form is used by a physician to request a medication or treatment for their patient that is otherwise not covered by the patient's insurance plan. SelectHealth will verify that the doctor has considered other options for treating their patient and that this is the only viable option to improve their patient's condition.
Updated November 15, 2024
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