What is a prior authorization or precertification?

Prior Authorization (PA), also known as precertification, is a process used by health insurance companies to determine if a specific medical service, procedure, or medication is medically necessary before it is provided to the patient. 

The process begins when a healthcare provider submits a request for prior authorization to the insurance company, detailing the patient’s condition and the proposed treatment. The insurer then reviews this information based on established guidelines to determine whether the requested service aligns with standard medical practices. Once the review is complete, the insurance company informs both the provider and patient of its decision. If approved, treatment can proceed; if denied, options for alternative care or an appeal are available.

Certain services are more likely to require prior authorization, and while specific requirements can vary by insurer, common examples include specialty medications, high-cost imaging such as MRIs and CT scans, surgical procedures, and some hospital admissions. Understanding which services may require prior authorization is vital for both patients and providers to navigate the healthcare system effectively.

Since HealthJoy is separate from your insurance carrier, we have no direct access to your Prior Authorizations. 

You should contact your insurance provider directly by calling the phone number available on the back of your member ID card or in the HealthJoy Benefits Wallet to check if the service has been preauthorized.

Even though you won't be able to see the status of your Prior Authorization (PA) immediately in the HealthJoy app, our concierge team can reach out to your insurance provider and request this information on your behalf. Once your request is processed, you will be able to find all the details regarding your Prior Authorization in your HealthJoy inbox.