Retroactively requiring pre-authorization
by jerry on February 09, 2020
The provider practice of surprise billing has made the news over the last few years. Kaiser Health News reports on a practice of insurance companies that I have not heard of before: retrospectively requiring pre-authorization. The practice of pre-authorization is commonplace and the intention is to help ensure that providers do not get too carried away and perform medically unnecessary tests and procedures. However, it appears that some insurers are not clear which procedures require pre-authorization and perhaps go as far as indicating that a patient does not need pre-authorization and then reverse their positions. Even worse is indicating to a patient that a procedure is pre-authorized and then denying payment for the procedure as "medically unnecessary" (Kaiser Health News notes footnotes on pre-authorizations to the effect of "This is not a guarantee of payment"). Obviously, this can cause financial and emotional hardship for patients who think they are abiding by the insurers' policies.
It is unclear how common this practice is compared to before, but this issue might gain more news coverage. If the industry is unable to resolve the issue in a reasonable manner, people will look to the government to intervene, similar to how laws against surprise medical billing have been enacted.