Issues swirling around insurance company Prior Authorizations (PAs) that determine access to care have jumped to prime time. PA is a process that requires healthcare professionals to obtain advance approval from the insurer before a prescription medication or medical service qualifies for payment and can be delivered to the patient.
In a recent article by SIIA‘s The Self-Insurer, Mike Lanza, senior vice president at USBenefits Insurance Services, LLC, emphasized that while PA is intended to ensure appropriate and cost-effective care, it is often misunderstood as a guarantee of payment. In reality, he noted, pre-certification is typically based on limited documentation and must still be reviewed against the plan document once the claim is submitted.
