What is a pre-authorization?

Pre-authorizations are regulations in California health insurance law that require insurance providers to review certain medical services and medications prior to providing coverage. This review is meant to ensure that the service or medication is medically necessary and that the approved coverage will be sufficient to cover the cost of the treatment or prescription. As part of a pre-authorization, the insurance provider may require the patient to receive a referral from a primary care physician or to receive care from an in-network provider. Additionally, the provider may require that the patient submit medical records to prove the necessity of the service or medication. Pre-authorizations are not required for all medical services and medications, but they are routinely required for more expensive treatments such as surgeries or long-term medications. Pre-authorizations are also often required for treatments or services that are not typically covered by insurance, such as cosmetic procedures.

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What is a pre-authorization?

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