Understanding Prior Authorization
Prior Authorization is the practice of getting certain medical services approved by CGHC before receiving treatment. Prior Authorization exists in order to give health insurance companies advanced noticed of certain claims that will coming in. It also can serve as a type of checks and balances system so that CGHC is able to validate that any planned care is medically necessary.
There are certain medical services that require Prior Authorization by CGHC before they will apply to your benefits. These can include tests, procedures, medical equipment and medications. CGHC’s Medical Management team oversees the Prior Authorization process to ensure our members receive medically necessary care.
All in-network providers should be aware that Prior Authorization must be obtained before they provide these services to you. However, it is ultimately your responsibility to be certain prior authorization was obtained in order to be applied to your benefits.