What is Prior Approval?

Prior approval, also known as prior authorization or pre-authorization, is a requirement by health insurance companies to obtain approval before certain medical services, procedures, or medications are covered. This cost-control measure ensures that proposed treatments meet the insurer's criteria for medical necessity and appropriateness. Common services requiring prior approval include expensive medications, advanced imaging, surgeries, and specialist consultations.

Why prior approval matters

• Affects access to care: Delays treatment until authorization is obtained
• Controls healthcare costs: Helps insurers manage expenses by reviewing medical necessity
• Creates administrative burden: Requires additional paperwork and communication between providers and insurers

How Solace can help

A Solace advocate can help navigate the prior approval process, ensure timely submission of required documentation, and appeal denied authorizations. Advocates can also coordinate between your healthcare providers and insurance company to expedite approvals for urgent treatments.