My family was insured here for over twenty years. First by Heath Net, then by Cigna and finally by Blue Cross Blue Shield. I never got anything pre-approved. I paid for the service, and filed the claim, and I got reimbursed.
A few times claims were denied, I contested the denial, and every claim was ultimately approved. Supplements were not covered, but they would sometimes be approved anyway.
They used to nitpick my annual physical and say some of the things were not covered, and only partially reimburse. Resubmit explaining it was a package, and it was approved.
I had twenty years of medical, including a rotator cuff and two knee replacements.
If you don't ask, the answer is no.