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Insurance Plans - Louisiana
Select the name of your insurance company to find out where to get forms
and to find contact information for your plan if you need to request prior
authorization or an exception.
This information was collected from the Web sites of the plans, and in some cases from e-mails and phone calls to the plans. It is provided here in an effort to make the information more conveniently available to you. We do not endorse any particular plan and we are not responsible if any plan has been inadvertently omitted from this list. We have not verified this information. In addition, we cannot be responsible for ensuring that the information is always up to date. Please notify us if you are aware that any of the information provided has changed. If you would like more detailed and current information, we suggest that you consult the Medicare Web site.
AETNA HEALTH INC
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
COVENTRY HEALTH AND LIFE INS COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
HUMANA HEALTH PLAN, INC.
LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY
Where to Get Forms: Call 1-800-376-7741 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-376-7741
Phone # to request Exception: 1-800-376-7741
Fax #: Not Available
E-mail Address: EFCorresp@bcbsla.com Updated: May 2006
MARQUETTE NATIONAL LIFE INSURANCE COMPANY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com Updated: May 2006
MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: Not Available
Updated: May 2006
MEMBERHEALTH, INC.
PACIFICARE LIFE AND HEALTH INSURANCE COMPANY
PENNSYLVANIA LIFE INSURANCE COMPANY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com Updated: May 2006
QCC INS CO D/B/A AMERIHEALTH INS CO
SILVERSCRIPT INSURANCE COMPANY
STERLING LIFE INSURANCE COMPANY
Where to Get Forms: http://www.foxrxcare.com/exceptions.htm
Phone # to request Prior Authorization: 1-888-369-7979
Phone # to request Exception: 1-888-369-7979
Fax #: 1-866-284-4509
E-mail Address: Not Available Updated: May 2006
TENET CHOICES, INC.
Where to Get Forms: Not Available
Phone # to request Prior Authorization: 504-461-4156
Phone # to request Exception: 504-461-4156
Fax #: 504-468-3611
E-mail Address: phn-pbmteam@peopleshealth.com Updated: May 2006
UNICARE
UNITED AMERICAN INSURANCE COMPANY
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com Updated: May 2006
UNITED HEALTHCARE INSURANCE COMPANY
Where to Get Forms: Call 1-877-665-6629 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6629
Phone # to request Exception: 1-800-207-2588
Fax #: 1-866-617-6705
E-mail Address: provider.relations@walgreens.com Updated: May 2006
WELLCARE HEALTH PLANS
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