Insurance authorization, without the back-and-forth
The OB office submits the initial authorization for new patients — including return patients with a new pregnancy. Once we've seen the patient at least once during the current pregnancy, we submit the follow-up auths. PPO plans don't require authorization at all. This page covers what to send with the initial submission, how long each payer typically takes, and how to flag a difficult case.
If the packet is complete on the first send, most auths clear in one cycle.
Who submits the authorization?Three scenarios · one rule each
Scenario A
Submitted by
OB office
New patient — or any new pregnancy. A return patient we've seen before still needs a fresh initial auth from the OB office at the start of every new pregnancy.
Applies to: first MFM consult of the current pregnancy.
Scenario B
Submitted by
Advanced Perinatology
Established patient — this pregnancy. Once we've seen the patient at least once during the current pregnancy, we take over and submit every follow-up authorization directly.
Applies to: follow-up ultrasounds, growth scans, NST/AFI series.
Scenario C
Skip auth entirely
PPO plans
No authorization required. PPO plans don't need a pre-auth for our services. Send the standard referral and we'll contact the patient to schedule.
Applies to: all commercial PPO plans · verify benefits if unsure.
02
Typical turnaround by payer
Business days from a complete packet to approval. Single-case agreements and stat requests not included.
Payer
Standard auth
Submission
Notes
Any PPO planCommercial PPO · all carriers
None required
N/A
No pre-authorization required. Send the standard referral and we'll schedule directly with the patient. Skip auth
Anthem Blue CrossPPO & HMO commercial
2–3 days
Availity portal
Most auto-approve same day if CPT codes match indication. Always include 76820.Fast
AetnaCommercial & Medicare
3–5 days
Availity portal
Detailed anatomy (76811) sometimes flagged for medical-necessity review — include clinical history.
Blue Shield of CaliforniaPPO & Trio HMO
2–4 days
Provider Connection
HMO requires referring-physician auth on file before the OB office submits the specialty auth. Confirm referral is loaded.
CignaCommercial
3–5 days
eviCore portal
Routed through eviCore for advanced imaging. Peer-to-peer often required for repeat ultrasounds.
United HealthcareCommercial & Medicare Adv.
5–7 days
UHC Provider portal
Detailed anatomy + echocardiography often bundled review. Plan ahead
Health Net · Molina · LA CareMedi-Cal managed care
5–10 days
Fax or plan portal
Slower than commercial. Submit as early as possible — do not wait for the visit week.
Medi-Cal fee-for-serviceStraight Medi-Cal
7–14 days
TAR via Medi-Cal
Treatment Authorization Request reviewed by state. Plan 2+ weeks of lead time.
Tricare · CHAMPVAMilitary
3–5 days
Tricare West portal
Need an active PCM referral on file. We'll request it directly if missing.
Out-of-network · single-caseSelf-pay alternative
Varies
Linda Carnow
We negotiate a single-case agreement (SCA) or refer the patient to our cash-price list. Flag early
03
Flagging a difficult case
Same-day escalation for urgent, denied, or unusual auths. Don't sit on it — loop us in early.
How to escalate
If a case is time-sensitive, has already been denied, or involves an unusual payer/finding, route it directly to our team rather than waiting for the standard queue.
01Mark the cover sheet with “STAT — auth assistance needed” and a one-line reason.e.g. “anomaly seen on anatomy scan”, “denied by UHC for 76811”
02Text or call Jessica or Lucy with the patient initials & DOB.Jessica Hernandez · (626) 701-2201 · Lucy Portillo · (626) 726-4282
03We loop in Linda for billing — she handles denials, peer-to-peer scheduling, and SCA negotiations.Same-day response during business hours
04We update your office within 24 hours with status, next steps, or an approved auth number.Reply on your preferred channel
04
Common denials & quick fixes
The six reasons we see weekly — and the one-line change that prevents each one.
Most common
76820 not in original auth
Umbilical artery Doppler is performed on almost every visit but is the most-omitted code on initial submissions. Without it, the day-of charge gets denied.
Fix: include 76820 in every auth, every time.
Frequent
Indication too vague
“Routine OB” or “AMA only” is often rejected for advanced imaging. The ICD-10 needs to map cleanly to the requested CPT(s).
Fix: use specific Z3A.xx + clinical indication codes.
HMO plans
Missing referring-physician auth
HMO patients need a referral from their PCP/OB on file at the plan before we can submit a specialty auth. Easy to miss on Blue Shield Trio & Health Net.
Fix: confirm your office's referral is loaded first.
Repeat visits
Add-on monitoring not authorized
NSTs, AFIs, and growth ultrasounds need their own auth quantity (we recommend ×10 per referral period). One-off auths cause repeated denials.
Cigna and some UHC denials are reversible with a peer-to-peer call, but they have a short window (often 7 days). Missed windows mean full appeal.
Fix: forward the denial to Linda the day it arrives.
Out-of-network
SCA not requested in time
Single-case agreements take 5–10 business days. If we don't know about an OON patient until the week of, the visit usually slips.
Fix: flag OON on the cover sheet immediately.
About these timelines. Turnaround windows reflect our recent average from a complete packet to approval, not a guarantee. Payer policies, plan tiers, and individual reviewer workload all affect actual response time. When a visit is time-sensitive, flag it — we'll prioritize the submission and start parallel patient outreach.