You can get a decision from your plan in advance to see if a service, drug, or supply is covered. You can also find out how much you’ll have to pay. This is called an “organization determination.” Sometimes you have to do this as prior authorization for the service, drug, or supply to be covered. You, your representative, or your doctor can request an organization determination. You also have the option to ask for a fast decision, based on your health needs. If your plan denies coverage, the plan must tell you in writing, and you have the right to an appeal. If a plan provider refers you for a service or to a provider outside the network, but doesn’t get an organization determination in advance, this is called “plan directed care.” In most cases you won’t have to pay more than the plan’s usual cost sharing. Check with your plan for more information about this protection.