Is it permissible for a patient to begin therapy before a prior authorization is completed?

In the context of prior authorization processes, it is important to understand that prior authorization is a requirement set by insurance companies to ensure that certain medications, procedures, or services are medically necessary before they are provided and covered by the insurance plan. When it comes to beginning therapy, the typical standard is that the prior authorization must be completed before treatment can begin. This is to safeguard both the patient's financial responsibility and the effective management of healthcare resources.

Patients beginning therapy without prior authorization might face significant financial burdens if the insurance does not cover the cost of the treatment after it has been administered. Therefore, in non-emergency situations, healthcare providers usually must wait for the authorization to be finalized to mitigate any risk of denying coverage for the treatment provided.

In specific contexts, such as urgent or life-threatening situations, there might be allowances for treatment to begin before obtaining authorization, but this is not the standard practice. As such, stating that the prior authorization process must be completed first reflects the standard protocol in most healthcare settings.