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Prior authorizations, sometimes also called preapprovals, can be confusing and frustrating for members. But these processes, which are common across all health plans, are necessary to ensure the treatment members have been prescribed is medically necessary and is the proper care.
Prior authorization is an important tool to ensure that the services, drugs, and devices patients receive are supported by current, credible medical evidence and are administered by a clinician with the appropriate expertise and training.
Premera’s medical director, Dr. Josephine Young, explains more about the process, and why it’s needed, in the video below.
To help determine if a medical procedure is appropriate, a team of experienced doctors, nurses, and healthcare analysts reviews each prior authorization request. It’s their goal to make sure clinical best practices are being followed and that every member is getting the care they need at an affordable cost.
Some common services that require prior authorization are:
This is not a complete list, but your doctor has the current list needed to request a prior authorization on your behalf.
By ensuring a given treatment or procedure is medically appropriate, the prior authorization process helps members:
If you have any questions regarding prior authorization or preapprovals, contact us today and get the help you need .
