Prior Authorization

Here is a detailed list of services that require prior authorization for any providers that treat Firefly Health members. We want to make this process as easy as possible for you.

The following services require prior authorization:

  • Advanced Imaging, including MRI/CT and PET/SPECT scans
  • Air ambulance services 
  • Cancer treatment programs, administered on an inpatient or outpatient basis
  • Colonoscopy/Sigmoidoscopy, if not covered by current ACA preventive care recommendations 
  • Diabetes education and supplies
  • Dialysis
  • Durable medical equipment costing over $500
  • Gender dysphoria medicines, hormone treatment, or surgical treatment
  • Genetic testing
  • Home health care
  • Inpatient or outpatient surgeries and anesthesia relating to, but not limited to, hysterectomies, back surgery, or any service deemed investigational or part of a clinical trial
  • Hospitalizations
  • Inpatient admission to free-standing chemical dependency, mental health, and rehabilitation facilities
  • Prenatal and maternity care, including breastfeeding support and counseling
  • Private duty nursing
  • Second surgical opinion consult
  • Skilled nursing facility stays
  • Specialty drugs
  • Therapies (including PT, ST, OT,  and cardiac care)
  • Transplants (including transplant evaluation)