When services are provided without expected preauthorization, what happens next depends on the insurer and the specific policy under which the patient is covered. Some insurance plans state that if a patient seeks services requiring preauthorization, but doesn’t obtain preauthorization, the patient is liable for covering the payment. If a provider neglects to obtain preauthorization and payment is denied by the insurer, it may come down to absorbing the cost of the treatment or trying to collect it directly from the patient, neither of which are good options.

The burden of obtaining pre-authorizations is on the provider because patients don’t know CPT codes and may not know when preauthorization is (or might be) required. Double-checking up front whether preauthorization is required may take some extra time on the front end, but with WMB teams of experts, it can save significant time trying to chase down claims and payments and prevent having to absorb costs for procedures that weren’t preauthorized.