Many insurance plans require notification of the health services your physician has ordered prior to you receiving them to make sure they are necessary and appropriate according to their guidelines. When this process is required by your plan but not performed, your service can be denied by your plan or the payment benefit reduced. The patient is responsible for payment for services that are denied due to incomplete prior authorization.

Outpatient

If you are to receive outpatient services that require prior authorization from your insurance plan you will need to inform your physician’s office of this requirement. Your physician’s office will need to complete this process prior to you receiving the services.

Inpatient Scheduled

If you are to receive a scheduled inpatient procedure or are an obstetrical patient you will need to inform your physician’s office if your insurance plan requires prior authorization. Your physician’s office will need to complete this process prior to you receiving the services.

Inpatient Unscheduled

When you have an unexpected inpatient hospital admission our Quality Review Department will contact your insurance company to complete the prior authorization process for you.