What is a Prior Authorization?

Certain medical services and supplies require approval before they will be covered by your plan. Prior authorization, also called prior approval or preauthorization, is the process where a qualified health care professional reviews and determines if a service is medically necessary. Your Summary of Benefits indicates which services, supplies or medications require prior authorization. All prior authorization requests are coordinated through your doctor’s office. Your doctor must ask for and receive approval before you receive certain care. Priority Partners will review the service, drug or equipment for medical necessity. If prior authorization is not given, then coverage for care, services or supplies may be limited or denied. Any costs for denied services that were the result of an in-network provider failing to receive prior authorization are not your responsibility. For more information on prior authorization guidelines through your Priority Partners plan, refer to your Priority Partners Member Handbook.