Fundamentos de Accidente y SaludPregunta 480 de 716
A managed care 'preauthorization' (precertification) requirement means the insured or provider must:
a.File a written police report with local law enforcement before any medical treatment is received
b.Obtain the plan's approval before certain services, such as a non-emergency hospital admission, to ensure coverage
c.Wait a full year after enrolling in the plan before receiving benefits for any hospital service
d.Pay the entire hospital bill up front before any care is delivered and then submit the itemized receipts for reimbursement
Explicación
Preauthorization (precertification) requires that the plan review and approve certain non-emergency services, such as a planned hospital stay or a costly procedure, before they are provided, both to confirm medical necessity and to ensure the service will be covered. It is not a requirement to pay the full bill first, to wait a year, or to file a police report. Managed care plans use preauthorization to control costs and steer care to appropriate settings.
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Revisado por John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verificar)