Prior Authorization

A prior authorization is often needed for an insurance company to cover your care. Issues with prior authorization often come down to poor communication between a provider’s office and your health insurance company. Other times, a denial to cover a medical treatment or diagnostic test is based on whether that intervention is deemed medically necessary or or is part of your insurance benefits.

No matter the case, our medical billing advocates can help to get things back on track. As your  authorized representative, we can help appeal the denial or help investigate other payment options.

Prior authorizations are often needed for:

  • Elective surgery
  • Specialist consultation
  • Out of state provider visits
  • Planned hospital stays
  • Expensive pharmaceuticals
  • Specialty Infusions
  • Expensive diagnostics like an MRI
  • Second opinions
  • Repeat diagnostics
  • Genetic testing
  • Specialty laboratory testing
One client was struggling to get her daughter’s specialist to correctly issue a prior authorization request. This was delaying her ability to make an appointment to receive time sensitive care. With the use of our team a prior authorization was received in less than 48 hours from her initial request for help.

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