Health is precious; it's something that everyone wishes for and strives to protect. Even so, most people do become ill at one time or another. In those instances, it is important to know exactly what will be required in order to take full advantage of the insurance options that are available. If a certain treatment will require prior authorization from the insurance company, it's best to know that before seeking treatment. In fact, the best time to learn about such coverage requirements is well before the insurance needs to be used - during the process of obtaining health insurance quotes.

Some insurance companies require prior authorization - also known as pre-authorization - for certain medical treatments. By doing this, insurers can confirm that treatment is only being given to patients meeting specific medical criteria. Determining when authorization is needed beforehand can save the patient or consumer valuable time and money. Thankfully, there are some simple steps that can be taken to determine if pre-authorization is needed. The first thing to determine is whether the facility or treatment provider is in network. The facility can usually confirm this, and if not, most insurance companies have this information readily available either online or in a handbook. With some insurance companies, any treatment received in network does not require authorization in advance. Still, it is always best to confirm the provider's network status before beginning any treatment.

If a medical service does require authorization, certain steps must be taken to ensure that the resulting claim will be paid. For example, the insurance company will want to know the correct member information (including member ID number) and provider information. Specific information about the services to be provided is also needed. Authorization may depend on the level of care being received (in-patient or out-patient) or the exact services being provided. Additionally, the insurer may require documentation such as failed treatments, diagnostic reports, a list of medications currently being taken, patient medical history or a statement of medical necessity. Much of this information will be supplied by the provider, but it does not hurt to follow up and make sure that the information gets to the insurance company in a timely fashion. In some instances, authorization for care may be denied. If that is the case, it is the responsibility of the provider to understand why the claim has been denied and file an appeal.

The bottom line is that everyone should know what is required for prior authorization in case the need arises. And the best time to discover this information is at the beginning of the process - while securing health insurance quotes.