Question

If it's known that a service may not be covered, a

Answer 1

Answer:

A. pre-authorization

Explanation:

Is it an authorization or a precertification?

Per Healthcare.gov, a decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost. This concept is not the easiest to understand. It would make sense that a notification and “approval” from an insurance company would then mean services will be paid. This is not the case and is precisely where the predetermination of benefits come into play, in addition to understanding reimbursement policies set up by payers themselves.