Definition
A utilization management process used by insurance companies to determine if a prescribed procedure, service, or medication will be covered. Getting prior authorization before treatment helps ensure your claim won't be denied. Failure to obtain required prior authorization can result in the full cost being shifted to the patient.
Related Terms
- Deductible
The amount you must pay out of pocket for covered healthcare services before you...
- Copay
A fixed amount you pay for a covered healthcare service after you have met your ...
- Coinsurance
Your share of the costs of a covered healthcare service, calculated as a percent...
- Out-of-Pocket Maximum
The most you have to pay for covered services in a plan year. After you spend th...
- Premium
The amount you pay each month for your health insurance coverage, regardless of ...
Understanding healthcare terminology helps you communicate more effectively with providers and make informed decisions about your care. Use our procedure cost database to find fair prices for any medical service.