The Advice Centre

Pre-authorization protects you from the unexpected when you claim

Tuesday, January 13, 2015
2   based on 184 votes
Insurance Basics, How to make a claim

Pre-authorization protects you from the unexpected when you claim

Are you planning to purchase medical equipment such as a scooter or a CPAP machine? Do you require costly dental work? We recommend that you request pre-approval for these and other high cost items before you make your purchase. This way you’ll know whether the item is covered, how much…and if there are any specific claiming requirements.

For instance, your insurance company may require an occupational therapist assessment for the purchase of a wheelchair. Doctor’s notes are usually required when claiming oxygen equipment. By sending your insurance company a request for pre-approval, you’ll know what to expect when you make the purchase and send in your claim.

Also, if you’ve reached your dollar or frequency limit for a covered item, your insurance company can advise when you’ll be able to make the claim in the future.

It’s always good to check with your benefit provider if you’re not sure if a pre-authorization is required for the item or treatment you want to purchase. Pre-authorizations may be required for items such as sleep equipment, wheelchairs, orthopedic braces, insulin pumps, oxygen equipment, major dental treatment or orthodontic treatment plans.

You, your dentist or your orthodontist can send in the proposed dental treatment pre-authorization. To submit a pre-authorization for medical equipment, you send in all the same paperwork that’s required to make the claim. This includes any doctor’s notes, quotes and any other items required for the specific item. Contact your insurer for details about what to include in the pre-authorization request. A little bit of leg work in the beginning goes a long way to provide you with peace of mind.

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