Feb 10, 2020 - Health

Insurers may not pay for care they've approved

Insurers are increasingly requiring patients to receive preapprovals for drugs or medical care, but even if the care is approved, that doesn't mean the insurer will necessarily pay, Kaiser Health News reports.

Why it matters: If an insurer decides not to pay for the care after the fact, that leaves patients on the hook for what can be huge medical bills.

Details: The preapprovals, often called prior authorization, may include a note that they're not a guarantee of payment, leaving insurers free to change their minds.

  • Patients also may be told that no prior authorization is required for a procedure, only to be told after they have it done that the insurer did want a prior authorization in this case — and thus isn't paying the bill.

The big picture: Prior authorization is already a controversial practice; providers say it's unnecessarily burdensome, while insurers say the practice helps to cut back on waste and excess costs.

The bottom line: Turns out there's yet another way for patients to receive a surprise medical bill.

Go deeper: Health insurers are eating higher medical costs

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