What is Preauthorization?

What is Preauthorization?

A pre-authorization is a restriction placed on your surgery by your insurance company that requires Myers Plastic Surgery to first check and be granted permission before your insurance will consider covering any surgery.
Sometimes they are called pre-approvals, or prior approvals, or prior authorizations, but they all mean the same thing. This practice is common in all types of insurance, even with government-sponsored coverage like Medicare, Medicaid, and Tricare.
When Dr. Myers decides that you need a surgery, and it requires pre-authorization from your health plan, Myers Plastic Surgery will put a request into your health plan to get approval to perform the surgery. Some plans allow patients to file their own prior authorizations, but most often this is a process that must be initiated with the doctor’s office.
Since Dr. Myers cannot possibly keep up with all the plan details for all his patients, it’s a good idea for you to look out for these possible scenarios. Asking your insurer about prior authorization is necessary and always a good idea.
So what does all this mean for you?
An approved pre-authorization is not a guarantee of payment, but it is a good indication of your health plan’s intentions to pay for a portion of the surgery. As well, if you do have an approved preauthorization, your insurance is not promising that they will pay any of the costs. You are still responsible for your share of the cost, as you would any service or medication, including any co-payments or coinsurance set forth by your health plan’s design.
Something to consider is that pre-authorizations are only valid for a specific amount of time and may require periodic renewal. For medications or ongoing treatments, the renewals work the same way that the initial prior authorization process. Often, for renewals, health plans are looking for information that the medication or treatment was helpful for your condition. If you received prior authorization for a test or surgery but do not schedule it during the timeframe the insurance company allowed, then your doctor’s office will need to resubmit to ask for approval once more.

Wesley T. Myers, M.D.
Plastic & Reconstructive Surgery
100 Medical Center Blvd. Suite 213
Conroe,TX 77304
Ph: 936-539-8115 FX: 936-539-8118