Prior Authorization
Also called: Pre-authorization, Pre-certification, Pre-approval
In plain English
A requirement from your insurance company that your doctor get approval BEFORE performing certain services, procedures, or prescribing certain medications. Without prior authorization, insurance may deny the claim entirely — leaving you with the full bill.
Real-world example
Your doctor recommends an MRI for your back pain. Your insurance requires prior authorization for MRIs. Your doctor's office submits the request, insurance reviews it (which can take days to weeks), and either approves or denies it. If you get the MRI without authorization, you could be stuck with a $3,000+ bill.
Why this matters for your bill
Prior authorization denials are one of the most common reasons for unexpected medical bills. Always ask your doctor if prior authorization is needed, and confirm it's been approved before having any procedure.
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