Which statement about preauthorization is most accurate?

• A. It is never used in managed care
• B. It is optional for most services
• C. It is often required before certain services under managed care plans
• D. It replaces patient consent

Answer: (C)

Preauthorization is a process where a health plan, especially managed care plans, approves a service before it’s performed to verify medical necessity and coverage. In managed care, many higher-cost or specialized services, imaging, procedures, or hospital stays require this prior approval so the payer agrees to cover the service in advance. That’s why the statement about being often required before certain services under managed care plans is the most accurate. It isn’t something that’s never used, and it isn’t simply optional for most services—many plans require it for specific categories. It also doesn’t replace patient consent; a patient’s consent to treatment is a separate matter from whether the plan approves payment for that treatment.