Of the7,444prior authorization requests we denied in 2023: 5,696were related to pharmacy benefits,1,656were related to medical benefits and92were related to behavioral health benefits 7,444were denied because the patient did not meet prior authorization criteria,0were denied due to incomplete info...
When your doctor recommends a treatment plan or medication that isn’t covered by your insurance, they may need to get pre-authorization (also known as prior authorization or precertification) from your insurance provider. The pre-authorization process allows your health plan to make sure you’re...