Click here for LACFF Prior and Retro Authorization Form

Click here for LACFF Prescription Drug Prior Authorization Form 

Services Requiring Pre-authorization, Retro-authorization, or Approval by Local 1014:  

• Artificial limbs and eyes (prosthetics).
• Autism treatment.
• Diabetes self-care instructions.
• Durable medical equipment purchase or rental.
• Genetic testing.
• Home health care.
• Home or outpatient infusion therapy or injectable drugs.
• Hospice care.
• Infertility treatment including pharmacy.
• Insulin pumps and continuous glucose monitoring devices.
• Medical splints and braces.
• Neuropsychiatric testing.
• Occupational therapy beyond 12 visits per year.
• Oxygen and rental of equipment for the administration of oxygen, or other mechanical respiratory equipment.
• Pain management procedures.
• Parenteral or enteral (nutritional) therapy.
• PET scans.
• Physical therapy beyond 30 visits per year.
• Specialty drugs authorizations.
• Speech therapy.
• Transitional nursing.
• Vision therapy.
• Medical weight-loss medications.

Services Requiring Pre-authorization by Anthem Blue Cross (prior authorization request must be submitted directly to Anthem):

• Inpatient stays in a hospital.
• Inpatient stays in a rehabilitation facility.
• Inpatient stays in an extended care facility.
• Intensive outpatient stays in a hospital.
• Organ or tissue transplants.
• Bariatric (weight-loss) surgery.
• Mental health care (Inpatient day or partial day treatment).
• Substance abuse care (Inpatient day or partial day treatment).
• Any procedure, whether inpatient or outpatient, that might be considered cosmetic, experimental or investigational.