What is prior authorization?
Sometimes specialists may suggest procedures we don't feel are the best course of action for a patient. That's why we want members to check with us so we can help manage their care. This is called prior authorization. If your service requires prior authorization, your doctor will take care of it on your behalf.
When Mary visits the ear, nose and throat doctor for the first time, she pays her specialist office copay. After her consultation, the ENT recommends a sinus surgery for Mary. Before she has the surgery, the ENT's office must get prior authorization from HAP to make sure the service is covered and that it's medically necessary.
Learn more about what procedures require prior authorization.