An authorization is permission to proceed. It is not a promise of payment.

THE PRACTICAL SIDE · COVERAGE

Two things about insurance and prior authorization are worth knowing before anything is scheduled, because both catch people off guard at exactly the wrong moment. A prior authorization is not a promise of payment. And coverage is decided per procedure, not per visit.

What is prior authorization?

It is your insurer (the payer) saying the planned service appears to meet its rules, based on the information sent in. It is permission to go ahead. It is not a guarantee that the claim will be paid. Payers say this in their own paperwork. Payment is decided after the fact. It is checked against your eligibility, how your benefits are set up, and the billing codes for what was actually done.

That gap is where most nasty surprises live. It is not a trick of any one practice. It is how the system is built. Knowing it ahead of time is the whole defense.

How is my coverage checked before treatment?

• Coverage is checked for the specific procedure before it is scheduled, not just for the office visit.
• If a service is not covered, you are told before it happens, not after.
• Some payers want a written record that other treatments failed first. When they do, we show you what that path looks like. We do not send you around it blind.

What should I ask my insurance company?

When you call your insurer, the single most useful question is not “do you cover this clinic” but “is this specific procedure covered under my plan, and does it need prior authorization?” Office visits and procedures are judged separately. People often confirm one and assume the other.

Does an insurance denial mean the treatment does not work?

When a payer declines to cover something, that is a benefit decision, not a scientific one. It reflects their rules and their contract. Do not read it as evidence that a treatment does not work. Sometimes a service that is not covered is truly the right option. Then you will be told what it is, why, and what the other option is. With that in front of you, the decision to go ahead is yours.

Frequently asked questions

Does prior authorization mean it will be paid?

No. It is approval to go ahead based on the information sent in. Payment is decided separately when the claim is processed.

Do you take my insurance?

Our staff checks your plan before anything is scheduled. Ask specifically about any procedure that has been suggested, not just the visit.

What if a treatment is not covered?

You will be told before it happens. You will also hear what it is for and what the other options are.

Do I need a referral?

No, you can book directly. Some plans do require one for their own reasons. That is worth checking when you call them.

Practical pages

• What to bring
• How long a workup takes
• What the visit covers
• Contact and booking
• Location and access