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Prior authorization requires your doctor or provider to obtain approval from your health plan before providing health care services or prescribing prescription drugs. Without prior authorization, your health plan may not pay for your treatment or medication. (Emergency care doesnt need prior authorization.)
The fundamental goal of prior authorization is to promote the appropriate use of medications.
Prior authorization (PA) is an essential tool that is used to ensure that drug benefits are administered as designed and that plan members receive the medication therapy that is safe, effective for their condition, and provides the greatest value.
If you dont get permission from your health plan, your health insurance wont pay for the service. Youll be stuck paying the bill yourself.
Your insurance wants a prior authorization, basically what that means is the Dr has to tell the insurance why they believe that their patient should get this particular drug. Then the insurance company can decide if they are going to pay for it or not.

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How To Get Prior Authorization: Step-by-Step Guide Step 1: Check client eligibility. Step 2: Determine if a code or service requires Prior Authorization. Step 3: Find and complete forms. Step 4: Submit a PA request. Step 5: Check the status of an authorization.

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