Preauthorization

Preauthorization (also known as prior authorization, prior approval, or preapproval) is a process used by certain health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication. The process is intended to act as a safety and cost-saving measure, although it has been criticized for adding complexity to the health care delivery process.

Process

The preauthorization process begins when a healthcare provider prescribes a procedure, service, or medication for a patient. The provider must then submit a request to the patient's health insurance company, detailing the need for the prescribed treatment. The insurance company reviews the request, taking into account the patient's current health status, the provider's recommendations, and the company's own coverage policies. If the insurance company approves the request, the treatment is considered preauthorized.

Criticism

Critics of preauthorization argue that the process adds unnecessary complexity to the healthcare delivery process. They claim that it can delay patient access to necessary treatments, and that it can result in additional costs for healthcare providers, who must devote time and resources to submitting and tracking preauthorization requests. Some critics also argue that preauthorization decisions are often made by insurance company employees who lack the necessary medical training to make such decisions.

See also

• Health insurance in the United States
• Healthcare in the United States
• Prior authorization

References

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