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CMS Treatment Preapproval Rules Will Drive Up Health Costs

Do prior authorizations make sense? Theoretically, yes. The patient needs treatment, the provider desires confirmation before furnishing the treatment that he/she will receive compensation for the procedure, and the insurer wants to confirm the services are necessary.

If the insurer authorizes the services, in theory, the provider should be able to rely on that authorization to perform the treatment. However, prior authorizations do not provide assurances of payment and impose financial and administrative strains on the health care system.