What is preauthorization?

Preauthorization is a process in healthcare where a healthcare provider must obtain approval from a patient's insurance company before certain procedures, treatments, or medications can be carried out. This usually pertains to elective surgeries, hospital stays, or specific high-cost medications. The purpose of preauthorization is to ensure that the proposed treatment is medically necessary and covered under the patient’s insurance plan, which helps control healthcare costs and prevent fraudulent claims.

The option referring to approval for elective surgery or hospital stay accurately encompasses this definition, as these types of procedures often require preauthorization due to their potential costs and complexity.

The other choices do not reflect the definition of preauthorization. A list of covered prescription medications pertains to a formulary and does not involve a prior approval process. A request for patient information is more related to gathering data for care or claims but does not imply a necessary approval step for treatment. Lastly, a denial of insurance claims involves the insurance company's refusal to pay for services rendered, which comes into play after the healthcare services have already been provided and is not related to the initial approval process that preauthorization entails.