Help Center

Pre-authorization is getting prior approval from your insurer before a procedure is performed to ensure that the procedure will be covered.

It should, however, pre-authorization does not guarantee that the service will be covered. It merely states that the insurer intends to cover the service, but on final review of the claim, your insurer may determine the service to have been unnecessary.

Not necessarily. If the service is covered and necessary, your provider may authorize and cover the service. Depending on your policy, failure to get pre-authorization for some services may cause it to not be covered.

Laws vary state to state, but many insurers are not required to provide pre-authorization for services, but do so as a courtesy.

Many non-emergency medical procedures and services require pre-authorization. If you are unsure, ask your provider. They are generally very familiar with which services typically require pre-authorization.

Your provider requests pre-authorization, so you need do nothing other than visit the provider and ask them if pre-authorization may be required. Your provider may have to present evidence of the necessity of the procedure by supplying your insurer with a report, lab and/or test results, scans, x-rays, photographs or other supporting materials that indicate that the procedure is necessary.

Although your provider can initiate the pre-authorization process on your behalf, they may not always do so and that may leave you with the bulk of the expense. It is the insured patient’s responsibility to know when pre-authorization is necessary. If you have any questions regarding whether pre-authorization is needed, contact your insurance company.