What Is Prior Authorization img

What Is Medical Prior Authorization and How Does It Work?

Your health insurance company may require approval before you schedule an exam or treatment from a medical provider. This type of approval is known as prior authorization. 

Prior authorization is not required for emergency or urgent care at emergency rooms or Urgent Care facilities. Prior authorization won’t prevent you from getting emergency room services. However, you may need prior authorization for non-emergency services.

Why Health Insurance Companies Require Prior Authorization

prior authorization ensures you receive services, treatments, procedures, and medications that are appropriate for you. It is designed to protect you from inappropriate or not medically necessary procedures. 

A health insurance company may request prior authorization for many reasons. New medical treatments and technology emerge all the time. Treatment is often in different stages of development. prior authorization allows health insurance providers to assess the safety and relevancy of those treatments for you and your condition.

A thorough review of treatment and services weighs the possible risks and side effects of participating in a given treatment. Prior authorization also confirms whether or not your current plan covers a proposed service or procedure. It is valuable information when considering the next steps in your treatment, plan, or regimen.

How to Find Which Treatment Requires Prior Authorization

For a full list of services, procedures, and treatments requiring prior authorization, look at your health insurance provider’s policy or contact them and speak to a health insurance agent. You can also discuss prior authorization with your health insurance broker.

Most policies provide a full list with a request form needed to get prior authorization for your health care provider. Contact your health insurance broker for more information on prior authorization and helpful tips. 

Once your provider receives an authorization request, they process it and respond in a letter or with a phone call. If you’ve created an account on the health insurance website, you can log in to check the status of your ongoing request on the 

How to Get Medical Prior Authorization

Once the health insurance company receives your authorization request, they review and respond to non-urgent requests within three to four days. Some services and treatments that are not emergencies can still be considered urgent. You may contact your health insurance broker or the health insurance company for high-priority situations like this.

The time it takes to review your request can vary depending on the situation and the health insurance provider involved. Sometimes, they may reach out to your provider for more information.