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The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patients insurance provider. As mentioned in the How does prior authorization work? section above, this will then often prompt a time-consuming back and forth between the provider and payer.
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.)
If you dont get permission from your health plan, your health insurance wont pay for the service. Youll be stuck paying the bill yourself.
Prior authorizations are usually only required for more costly, involved treatments where an alternative is available. For instance, if a physician prescribes an invasive procedure such as orthopedic surgery, it will likely require preauthorization.
If you need prior authorization, your doctors office will process the request for you at no charge. They will follow up with your insurance company until the request is approved or denied. This process can involve a great deal of back and forth.
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