Understanding Prior Authorization for Gastroenterology

No matter how swift or sluggish our digestive system processes food, our metabolism is determined by the energy our cells absorb from the food we eat. However, when a glandular disorder affects metabolism, it’s time to see an endocrinologist. Seeking comprehensive gastrointestinal care is important, regardless of one’s financial status.

There are organizations and insurance companies in USA to assist and accommodate a variety of financial situations for the convenience of needy patients. If your income is not sufficient to cover your health care costs and you have been unable to establish a mutually agreeable payment plan, you may be eligible for a discount through an insurance assistance program by the federal government. In that case, before any appointment is set, the insurance plan needs to be determined that can provide specific benefits covering the pain area.

The purpose of Prior Authorization is a process to assist in the proper implementation of medication. Basically, a pre approval or prior auth is a prior request to a particular health plan where certain medical details need to be reviewed along with the necessary clinical documentation to support the request. An accompanying reference guide provides valuable health plan with the specific information. The standardized Prior Authorization form is not intended to replace payer specific prior authorization processes, policies and documentation requirements. It is designed to serve as a universally accepted form to be used by multiple health plans, and is intended to assist the providers by streamlining the data submission process for select services that require prior authorization.

As soon as the insurance information is provided, the claims are submitted that is required to get paid. Once the insurance claims are processed, the medical billing is done accordingly.

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