Health Insurance Basics
What is health insurance prior authorization?
Prior authorization is a requirement that your doctor get approval from your insurance company before providing certain medical services. Prior authorization is required for many services including specialist visits, inpatient hospital stays, outpatient procedures, and specialty medications. Failure to get prior authorization can result in denied claims.
Key Points
- Prior authorization: insurance company approval required before certain services
- Required for: specialist visits, inpatient stays, procedures, specialty medications
- Failure to get prior auth: can result in denied claims
- Emergency care: does not require prior authorization
- An independent agent can help you find plans with fewer prior authorization requirements