Why Do Health Insurers Require Prior Authorization?
Health Insurers and Prior Authorization Like sands through the hourglass, so are the days of prior authorization “This procedure will require prior authorization.” Words that no patient or healthcare provider wants to hear when they are ready to proceed with a doctor-approved procedure for a medical matter. However, it’s one of the utilization management tools that insurance companies have fostered to decide if specific prescribed procedures, services and medications are medically required or whether there is an equivalent useful treatment existing for the patient. Healthcare.gov defines prior authorization as “approval from a health plan that may be required before you get a service or fill a prescription in order for the services or prescription to be covered by your plan.” Importantly, services (medications, imaging studies, etc.) that need prior authorizations require healthcare providers to acquire consent from the patient’s health insurance...