What is Prior Authorization in Health Insurance?

Prior authorization is mandatory for complex treatments, certain prescriptions, and medications that may pose safety risks when combined with other drugs. Key requirements include a consultation with your healthcare provider to assess the need for authorization and the submission of documentation proving medical necessity. Coverage limitations include the absence of prior authorization, cosmetic treatments, and potential exclusions based on specific insurance plans or services not covered by the No Surprises Act.

"Prior authorization is required for complex treatments or prescriptions."

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