Doctors and other healthcare providers often need to get approval from insurance companies before they can provide certain treatments, medications, or procedures to their patients. This process, known as prior authorization, is used by insurers to determine whether a particular treatment is medically necessary and meets their coverage requirements.
How Prior Authorization Works
If an insurance company denies a prior authorization request, the doctor or their staff may appeal the decision by submitting additional medical information or speaking with the insurer’s medical reviewers. Some hospital systems, like Yale New Haven Health, have specialized staff to help manage the prior authorization process.
Original reporting: The Connecticut Mirror — read the source article.
