Pre authorisation means that a health provider must obtain approval from a patient’s health plan insurer and then proceed with a treatment, medication, or procedure. 72% of providers state that Pre authorisation results in delays in prescribing medications. This means that with the adoption of Pre authorisation, the delays in medical treatments have to be eliminated. Let’s get into the details of what is Pre authorisation, its significance, types of medications requiring it, and more relevant details.
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As you have read about what is authorisation in healthcare, it is also important to understand that pre-authorisation process helps insurance companies control costs and ensure that the treatment was necessary. Even if a treatment is covered under an insurance plan, without Pre authorisation, the company may refuse to pay for it, leaving the patient responsible for the full cost.
With pre-authorisation, insurance providers determine whether or not a medical service is mandatory before giving the approval. You are now familiar with what is a Pre authorisation and how it works, so let’s get into the details of the type of medical requirements that need it.
Here’s a sample list of medications and treatments that need Pre authorisation.
Understanding these key aspects of what is a Pre authorisation are essential to ensure safe and cost-effective medical treatment.
Pre authorisation is usually not required in emergencies. Insurance companies know about what Pre authorisation for medication is and also know that waiting for approval could be risky. Hence, the Affordable Care Act (ACA) ensures that patients get urgent care without any delays.
In addition to knowing how long pre-authorisations take, you must also know how the process works. It will give you clarity on the benefits of this process for patient care.
If you skip Pre authorisation, it may result in denials of insurance claims. This means you may have to pay the full cost of the treatment or medication.
If a claim is denied due to missing Pre authorisation, healthcare providers can request retroactive authorisation in certain cases.
If your Pre authorisation request gets rejected, first check the reason. The denial may be due to incomplete documents or inappropriate medical requirements.
Consult with your doctor to get the corresponding medical proof and then submit an appeal to your insurance provider. This procedure can help clarify why the treatment is required.
Check whether your insurer supports cheaper medicines whose prescription can be given without any additional approvals.
Incorporating these tips can ensure a smooth procedure of pre authorisation.
Understanding what is Pre authorisation is essential because it helps control healthcare costs and avoids unnecessary treatments. However, it may slow down the patient's care. It is essential to know the requirements, submit all necessary documents, and know the approval process.
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Reviewed by Dr. Harshita Dahiya 
Acko Technology & Services Private Limited
#36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102
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