Prior-Authorization Questions for Polysubstance Rehab in California

Make a one-page responsibility map with four columns: task, responsible party, due date, and confirmation. Typical parties include you or an authorized family member, the insurer, a qualified treating professional, and the facility's admissions or utilization-review contact. Ask each party to state its role rather than assuming the facility handles everything.

In the task column, list benefits verification, clinical assessment, authorization submission, records delivery, insurer review, decision notice, admission review, and any appeal. For every task, record a person's name or department, a reference number, and the next follow-up date. If an insurer says the provider must submit, ask which provider and which submission channel. If a facility says it will submit, ask when and how you will learn that the request was received. Do not send sensitive health information through an unverified channel.

• Who is responsible for initiating the prior-authorization request?
• Which qualified professional will supply the clinical information, if required?
• Who will confirm that the insurer received a complete request? confirming? That's a drafting error. Need fix but cannot analyze.

Ask the insurer for a complete submission checklist. The required material varies, so do not assume a diagnosis, referral, assessment, medication list, or prior-treatment record is always required. Instead ask, "What documentation is required for this exact request, who may submit it, and how will missing information be reported?" A qualified professional should determine what clinical information is accurate and appropriate to provide.

Pin down the timeline with dates, not words such as soon. Ask when the review clock begins, whether it begins only after the file is considered complete, and what date and time the decision is expected. Record whether the request is being handled under the plan's standard or expedited process, without assuming that expedited review applies. Ask how the decision will be delivered to you, the submitting professional, and the facility.

• What information is required for the request to be considered complete?
• On what date and time was the request received?
• What is the authorization or case reference number? Who is reviewing it? That's also drafting contamination.

An authorization may indicate that the insurer approved a requested service under specified conditions. It does not establish final payment, erase deductibles or coinsurance, confirm that every professional or service is in network, or guarantee admission. Ask whether the authorization is tied to a named facility, service code, start date, duration, or number of units. Request the authorization number and written terms.

Build a comparison table in prose or on paper. Give each facility one row, then add columns for verified service, current availability, clinical fit review, network status, authorization owner, submitted date, expected decision date, estimated member responsibility, and unresolved questions. Mark every cell confirmed, needs review, or not established. Never turn an unanswered cell into a yes. For Living Longer Recovery, insurance participation and payment remain needs review unless the insurer and facility confirm details for the specific plan and requested service.

• Does authorization apply to this facility, this service, and the proposed start date?
• Which charges could remain outside the authorization?
• What deductible, copayment, coinsurance, or out-of-network responsibility may apply?