Why is Prior Authorization Necessary?

Health insurance providers use prior authorization as a method to control healthcare spending. It helps prevent overuse or misuse of expensive services, ensuring that patients only receive treatments that are necessary and covered under their insurance plan. Prior Authorization also ensures that the prescribed treatment is medically necessary. Insurance companies assess whether a procedure, test, or medication meets specific guidelines that prove it will benefit the patient, aligning with evidence-based standards of care.

Overall, navigating the prior authorization process can be tedious and time-consuming. However, in order for medical centers to provide the necessary assistance in a timely manner, and for clients to receive it, it is important to clearly understand who is responsible for getting pre-authorization and how to go through this process. Pharmbills, a leader in healthcare revenue cycle management, offers expert services to streamline the prior authorization process.