While there are many variables impacting the state of healthcare in the United States, there is one goal that both beneficiaries and insurance providers must realize is important: providing people with the quality healthcare they need. By creating systems that enable more people to access care, people’s quality of life and life expectancy can continue to improve.
At Allied Pharmacy, we are committed to doing everything we can to ensure that each patient receives the best possible care. That’s why we offer a comprehensive service that works with each patient’s personal care team, including insurance companies and physicians.
What is pre-authorization/pre-authorization?
According to health.gov, Prior Authorization(also known as pre-approval, pre-approval, and pre-certification) is “a health insurance company’s approval that a medical service, treatment plan, prescription drug, or permanent medical device is being used. These decisions are made by licensed medical professionals who make decisions based on established and professionally recognized criteria and standards. In other words, pre-approval allows the insurers licensed medical professional to determine if a particular product or service would benefit. The U.S. Government Accountability Office explains: Goods or services were provided. ”
What are the benefits of prior authorization?
Reduce unnecessary use. In the medical world, people often receive treatments that are medically unnecessary and, in some cases, even harmful to certain patients. Unnecessary treatments increase overall health care costs. As a result, medical plans that include preapprovals often allow beneficiaries to have lower deductibles and premiums. The Medicare system alone saves billions of dollars annually by implementing preapprovals.
Additionally, prior approval helps combat unnecessary prescriptions and overdoses. A 2018 study released by the Department of Health and Human Services claimed that “an estimated 10.3 million people over the age of 12 abused opioids in the past year.” Specifically, 9.9 million people abuse prescribed pain relievers, concluding that “adequate opioid prescribing is essential to protect the health and safety of Medicare recipients.”
Leveraging preapproval
Leveraging preapproval should make the health insurance industry a little more predictable. Setting a clear precedent for whether a particular product or service is covered by an insurance plan can help expedite necessary treatment and resolve financial ambiguity. By reducing ambiguity, beneficiaries of certain medical plans can avoid costly out-of-pocket payments. You can also make sure that you are receiving treatments that are clinically proven to treat your current condition. The environment surrounding health insurance is constantly changing. With each passing year, the range and quality of available healthcare treatments continues to evolve, enabling providers to treat more specific conditions than ever before. While the surge in preapproval in the industry has some drawbacks, it has helped industry leaders allocate resources more efficiently and provide recipients with the care they need.
How do I know if something is covered by my current insurance?
Even with preapprovals guidelines in place, it can be difficult for many people to know exactly what their current health insurance plan covers. It can be especially difficult if you need to change plans or seek alternatives to the treatment you are currently receiving. If you are unsure whether a particular condition or condition is currently covered by your health insurance company, you should contact your health insurance company first. Most carriers have valuable resources available to him 24/7.