“Preauthorization” is a health-insurance term you might have been hearing lately. What is it, and how does it work? We asked Lalonie Moore and Dane Graves, both part of Memorial Regional Health’s Prior Authorization team, to answer some important questions.

Q. What is preauthorization
A. Preauthorization, also called prior authorization, is an insurance company’s pre approval that a certain test, procedure, service or piece of medical equipment will be covered for a specific patient and at what level of coverage.

Q. Which tests and procedures require preauthorization?
A. Different insurance companies have different rules. Most require preauthorization for MRIs, cardiac-event monitoring, in-lab sleep studies and surgeries, for example. But the MRH Prior Authorization team checks every provider order to determine if preauthorization is needed and to process the preauthorization when it is.

Q. Do all insurances require preauthorizations?
A. Yes, including Medicare and Medicaid. For patients who self-pay, the Prior Authorization team reviews provider orders to provide the patient with an estimate.

Q. What does the patient need to do?
A. The preauthorization process happens automatically. It can take anywhere from a day to two weeks. The Prior Authorization team then notifies patients of their insurance company’s decisions and coverage levels. If something is denied, the patient may contact their insurance company to advocate for reconsideration.