Preauthorizes

Preauthorizes refers to a process where a healthcare provider or patient requests approval from an insurance company before receiving certain medical services or treatments. This is often done for procedures, medications, or durable medical equipment that are considered non-emergency, expensive, or require specific medical necessity documentation. The purpose of preauthorization is to ensure that the proposed service is medically appropriate and covered by the patient's insurance plan, thereby helping to prevent unexpected out-of-pocket costs for the patient and potential claim denials for the provider.

The preauthorization process typically involves the healthcare provider submitting a request to the insurance company, including detailed clinical information and justification for the service. The insurance company then reviews the request based on its policy guidelines and medical necessity criteria. If approved, the insurance company issues a preauthorization number, which serves as confirmation that the service is likely to be covered, assuming all conditions of the policy are met. If denied, the provider may have the option to appeal the decision or explore alternative treatment options. The time frame for preauthorization can vary, but it is generally recommended to initiate the process well in advance of the scheduled service to avoid delays.