Healthcare shouldn’t be this complicated. Learn the terms that matter to make informed decisions about your health.
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.
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.