What Is Pre-Authorization And How Can It Cost You Money?

Pre-authorization is something that your health insurance uses as a hoop for you to jump through in order to receive your benefits. But why do they do it? Well, honestly because they want to examine the thought process behind the treatment while also requiring a little more forethought about procedures prior to having them done.

Pre-authorization may be used to deny claims, because if you are required to obtain pre-authorization for treatment and then the insurance company can not say that did not meet the criteria for having covered up and the procedure will therefore expect you to pay for this procedure out of pocket. If you look at your health insurance policy is important to understand when you will be required to obtain pre-authorization for health care as this can vary from policy to policy.

Now pre-authorizations can really help you out especially if you are going to an out of network provider when dealing with an HMO or PPO plan. Outside providers will need to contact your insurance company with a plan of treatment prior to completing anything beyond a routine office visit. While this may seem to take some time and be a hassle having this information will allow you to make informed choices about your health care.

Once you look at the EOB sent by your health insurance company you will be able to see exactly what they will cover and the total amount out of pocket that you will be responsible for. This will help you to financially plan for your treatment and if the cost seems to be over the top then you will probably choose an in network service provider to complete your treatment as usually this will result in a much smaller out of pocket expense for you. It is important to realize with certain plans the physician you choose is just as important as the treatment you are receiving.

The pre-authorizations that are required by your health insurance company can hurt you financially if you are not aware of them so it is important to take time and find out when and where you need to contact your health insurance company before treatment. Making that call is a simple thing, but it can help save you from the risk of a large medical bill at the end and may allow you peace of mind in knowing that you are having the procedure done will be covered by the insurance company.

Be careful with any soon to be changes to your health insurance. It is safe to understand what is happening with Health Insurance plans that will affect you directly.