What is prior authorization, or prior plan approval?
Sometimes we review certain proposals for medical services or drugs in advance to make sure that the service or drug is right for the patient. There are several names for this procedure, including prior plan approval, prior authorization, prospective review, prior review, certification or pre-certification. Benefits and coverage vary by plan, and even if a doctor receives prior plan approval it does not guarantee payment. For more information, please refer to your benefits booklet. Important note: In case of emergency, prior approval is NOT required. An emergency is an instance in which the absence of medical attention could jeopardize a person’s life, health, or ability to regain maximum function, or could subject a person to severe pain.
