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A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.
Prior authorization is often required by insurance companies for services such as MRI's, PET scans and many prescription medications. When a prior authorization is requested it means that the insurance carrier needs more information before making a final decision on whether it will be covered.
Prior authorization is a process by which a medical provider (or the patient, in some scenarios) must obtain approval from a patient's health plan before moving ahead with a particular treatment, procedure, or medication. Different health plans have different rules in terms of when prior authorization is required.
Q What procedures require prior authorization? A The advanced diagnostic imaging studies requiring prior authorization under the program are: CT scans, MRIs, PET scans, MRAs and Nuclear Cardiology.
Prior authorization (also called \u201cpreauthorization\u201d and \u201cprecertification\u201d) refers to a requirement by health plans for patients to obtain approval of a health care service or medication before the care is provided. This allows the plan to evaluate whether care is medically necessary and otherwise covered.
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Prior authorization is often required by insurance companies for services such as MRI's, PET scans and many prescription medications. When a prior authorization is requested it means that the insurance carrier needs more information before making a final decision on whether it will be covered.
No pre-authorization is required for outpatient emergency services as well as Post-stabilization Care Services (services that the treating physician views as medically necessary after the emergency medical condition has been stabilized to maintain the patient's stabilized condition) provided in any Emergency Department ...
Beginning July 1, services requiring prior authorization will include vein ablation, blepharoplasty, injections, panniculectomy and rhinoplasty.
An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.
A pre-authorization is a restriction placed on certain medications, tests, or health services by your insurance company that requires your doctor to first check and be granted permission before your plan will cover the item.

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