In plain English
This means getting the insurer's approval ahead of time for a particular kind of care or medicine. The approval applies to a specific service, treatment, or prescription drug. It is required in advance as part of the coverage condition.
In context
Here, "prior authorization" names the insurer-approval process that must be obtained in advance for the service being discussed as a condition of coverage.
- Situation
- Checking provider networks, authorization, referrals, eligibility, and preapproval states
- What it communicates
- names the approval process referenced before a service.
Meaning limits
The term alone does not show whether that approval has already been granted or whether coverage will ultimately apply.
Examples
“The insurer requires prior authorization for the MRI before covering it.”
“The receptionist handles prior authorization for specialist treatments.”