What is a prior authorization?

A prior authorization is a requirement under Florida health insurance law that an individual must obtain approval from an insurance company before receiving certain medical services. This approval is required to ensure that the service being provided is medically necessary, that it is covered by the individual’s policy, and that the cost of the service is within the policy’s coverage limits. A prior authorization is often needed for specialty services, such as certain types of surgeries, physical therapy, and mental health counseling, as well as for higher-cost medications, such as brand-name drugs. In Florida, prior authorization is required for some services when the medical provider is participating in a network with the health insurance plan, depending on the terms of the plan. If an individual needs a service but doesn’t have prior authorization, they may be responsible for the full cost of the service.

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What is a prior authorization?

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