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Medical Billing Pre-authorisation Importance

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With medical costs on the rise, having health insurance is a smart decision. However, simply owning a policy isn’t enough; you need to understand how it works to avoid unexpected expenses and surprises later on. One key term to know is pre-authorisation, which means getting approval from your insurance company before going ahead with certain treatments or procedures. This is an important step, and skipping it can lead to your claim being rejected. In this blog, we will explain why pre-authorisation is significant for medical billing and claim approval, and highlight the types of procedures that require it.

What Medications/Procedures Need Prior Authorisation or Approval?

Some medicines are more likely to need your insurance company’s approval before you can get them. These include:

• Drugs with serious side effects or safety risks

• Expensive medications, especially if there is a cheaper option that is equally effective

• Drugs that can be misused or lead to addiction

• Medications used for both medical and cosmetic reasons. For example, if a drug approved for diabetes is also approved for weight loss, your insurer may only cover it when prescribed for diabetes.

• Specialised or high-cost treatments, such as chemotherapy, hormone therapy, or newly approved/experimental medications

Medical procedures that often need prior authorisation

Some tests, treatments, or services also require prior approval. These commonly include:

• Advanced imaging tests like MRIs, CT scans, or PET scans

• Home healthcare, including in-home nursing or therapy

• Planned (non-emergency) surgeries, also called elective surgeries

• Rehabilitation services, like physical or occupational therapy

• Medical equipment, such as wheelchairs or oxygen machines

• Treatments that might not be right for your health condition or could cause problems based on your medical history

• Cosmetic procedures, unless related to a medical condition or injury

What is the Significance of Prior Authorisation in Claim Acceptance?

Prior authorisation helps avoid billing issues and keeps the payment process smooth. Insurance companies use it to check if a treatment is necessary and covered before they pay for it. However, even with prior authorisation, claims can still be denied if the process is not followed properly. To avoid this, it is important to keep the following points in mind:

• Include the authorisation number:

Always add the Prior authorisation number when submitting a claim. Missing it is one of the main reasons claims get denied.

• Get approval before treatment:

Make sure you get approval for non-emergency treatments, especially costly ones. If it is a medical emergency, insurers may approve it afterwards.

• Make sure the full treatment is approved:

Sometimes, only part of the treatment is authorised. So, if the rest is not approved, the claim could be denied.

Conclusion

Pre-authorisation is a key step in medical billing and claims, so it is important not to skip it. With online preauth and claims management now available, the whole process is faster, easier and involves less paperwork. Additionally, it helps identify errors early on, before they result in claim denials or unexpected bills.

If you don’t have health insurance or critical health insurance, you can easily buy one online in just a few clicks. Buying health insurance online is quick, simple and saves you from all the paperwork. It is a smart step to stay prepared for medical emergencies.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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