What Is an Insurance Authorization?

Insurance authorization is the process of contacting the insurance company to obtain assurance that your insurer will pay for the services you are seeking. Acquiring an authorization is common policy for doctor offices, medical facilities, automotive body repair shops and restoration businesses. Although services usually begin upon receipt of an insurance authorization, there is no guarantee your insurer will provide the authorization.

Medical

• Medical insurance typically covers routine office visits, physical examinations, emergency room care and medications found to be medically necessary. In many cases, you need insurance authorization to receive or continue medical treatment. Some of these services include hospital admission, fertility services, weight loss surgery, cosmetic surgery, imaging services (MRIs and CATs), and medications that are not medically necessary. Whenever possible, ask your insurance company about qualification standards, coverage for procedures, medications, pharmacies and other specifics about the services you are seeking.

Automotive

• After a collision, you usually have your car taken to an auto body shop for repairs. The shop typically contacts the insurance company to provide a damage estimate, and get an insurance authorization to perform the repairs on the insured vehicle. The insurance company may send its own appraiser to make an estimate of the cost of repairs. If the insurance company does not give authorization, the repair shop will not begin the repair process because the claim will not be paid.

Property

• Storm, water and fire can cause significant damage to your home or business. Cleanup and restoration can cost thousands of dollars. An insurance company property adjuster evaluates the damage, then the insurer's underwriting department accepts the risk and provides authorization. The insurer also might determine whether you can remain in your home or continue to operate your business.

Benefits

• Insurance authorization assures you that claims will be paid. That way, you will not face unexpected out-of-pocket expenses during a medical crisis, car accident, fire or flood. Service providers are experienced in doing business with insurance companies and are familiar with common procedures. Getting your insurer's approval gives you a level of comfort during an otherwise-stressful event.

Preparation

• Long before the claims process begins, it is important to become familiar with your policy coverage. Get acquainted with the coverage and exclusions. After reviewing the policy and procedures, ask your insurance company representative questions about anything you don't understand fully. Maintain a file of your insurance documents for reference, and keep them in a safe place. This will help your claims process go smoothly and avoid any delays with an authorization.