A cost containment feature of many group medical policies whereby the insured must contact the insurer prior to a hospitalization or surgery and receive authorization for the service.----------[ Back
A method that insurers and managed care companies use to monitor and control the delivery of medical care by evaluating the need for a service before the patient is allowed to receive care; it is usually done by trained, mid-level providers, such as nurses.
a determination by the carrier that the services are medically necessary and appropriate
A requirement of some health insurance plans to obtain permission for a service or procedure before it is done and to see whether the insurance program agrees it is medically necessary.
the act of prior authorizing or getting prior approval. A preauthorization letter is written by a physician to an insurance company and explains in detail the procedure a physician plans to perform and requests confirmation that the planned services are covered.
A voluntary process that allows physicians and other professional providers to determine, before treating a patient, if BCBSM will cover the cost of a proposed service.
A method of monitoring and controlling utilization by evaluating the need for medical service prior to it being performed.
A procedure used to review and assess the medical necessity and appropriateness of elective hospital admissions and non-emergency Outpatient services before the services are provided.
An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures (like outpatient surgery) in order for those procedures to be considered a covered expense.
A written promise, which may include some conditions, from an insurer to pay for a specific medical treatment for a patient who made the request.