Ask the insurer whether prior authorization, precertification, or notification applies to the proposed service. If authorization is required, ask who may submit it, where it goes, how long review usually takes, what the effective dates are, and whether additional review is required after admission. Ask what happens if the level or duration authorized differs from what is billed.
Request the authorization number and written decision. Then say, “Does authorization guarantee payment?” The expected answer may be no because payment can still depend on eligibility, benefit limits, claim coding, medical-necessity review, and other plan terms. Ask about appeal rights, deadlines, records needed, and whether an expedited process exists under your plan when a qualified professional considers delay clinically urgent. This is a plan-process question, not a promise that expedited review will be granted.
- Authorization requirement and submission responsibility confirmed
- Requested service and authorized service compared word for word
- Effective dates, units, and continuing-review schedule documented Authorization number and written decision saved Denial reason, appeal route, deadline, and required records