Wednesday, March 7, 2018

The Importance of Insurance Authorizations

An experienced healthcare and research professional, Devansh Parikh is an office manager at a busy medical clinic in Fayetteville, North Carolina. In this role, Devansh Parikh's responsibilities include patient coordination, patient database management, and staff management. Additionally, Mr. Parikh works with insurance companies to obtain insurance payments and authorizations.

An insurance authorization, also called a preauthorization or a prior authorization, is a requirement of many health insurance policies. At its most basic, an authorization indicates the insurance company has determined that the proposed treatment is medically necessary. 

This determination makes it more likely the insurance company will cover the procedure under the terms of the policy. Typically, the doctor’s office or medical facility will work with the insurance company to obtain the authorization, but patients should also contact their insurance companies to determine if an authorization is needed.

If an authorization is required but not obtained, a health insurance company may deny the payment, leaving the patient on the hook for possibly thousands of dollars. However, an authorization does not necessarily mean the insurance company will cover the entire bill. The amount covered depends on the insurance policy and applicable co-payments and out-of-pocket limits designated in the policy.