Effect of Pre Authorization in Medical Insurance

The pre-authorization in medical insurance refers to the determination of the factors which are essential for the proper treatment of the patient.  In order to determine the important factors, the medical history of the patients and reasons for visiting the general practitioners or the health service providers are evaluated by the insurance company.

The pre-authorization is required in many cases for the general practitioners or the health service providers to submit valid documentation to the insurance company about the necessity of a particular drug or procedure of treatment chosen for a patient. In some cases is the pre-authorization is rejected then the patient can resubmit his claim to the insurance company to avail the required medicine and treatment essential for his cure. In case of emergency treatment, the response time from the insurance companies is usually short and the claim can be processed within 24 hours.

pre authorization for medication is an insurance coverage which is granted by the insurance company.  The insurance company decides after evaluating the medical history of the patient that whether the treatment or the medicines are essential for the patient or not.

The prescriptions that require pre authorization

The following type of drugs required pre-authorization from the insurance company.

●       The branded medicine switcher available in the generic form.

●       The drugs which are used for cosmetic purpose only.

●       The drugs which are not preventive medicines and they and neither used as life-saving medicines.

●       The medicines which are known to have adverse side effects.

●       The drugs which have the potential to become addictive and they are abusive for the health of the users.

●       The drugs which are not covered in the medical insurance but they are prescribed by the out of Necessity.

The pre-authorization is intended to secure the fact that the drugs are being used appropriately and the patients can get the most cost-effective treatment. The pharmacy notifies the Healthcare providers whether the prescription of a patient requires free authorization or not.  The health care providers inform the insurance company who take the decision about covering those medicines in the insurance and inform the pharmacist as quickly as possible.  The pre-authorization period is limited and if it is required in future the patient has to apply to the insurance company for pre-authorization with the help of pre authorization medical form.

Things to do if the pre authorization is cancelled

The patient under the insurance coverage can submit an apple in case the pre-authorization is denied.  The health service providers support the claim of the patients by giving valid reasons for the necessity of those treatments and medicines.  These medical notes are very helpful to who make the claim passed by the insurance companies.

The prescription for high dose medicines conceived the cost and also the 90 days’ supply of medicines can be cheaper than the 30 days’ supply of the medicines.  If the patient is filing pre-authorization for expensive medicines then and it is recommended to look for the discounts and patient assistance programs which are effective to cut the cost.