Which step of the prior authorization process informs both the patient and provider of potential hurdles in receiving insurance approval?

The step of insurance verification is critical because it serves as a checkpoint in the prior authorization process that directly impacts both the patient and the provider. During this step, the provider contacts the insurance company to confirm the patient’s coverage and the specifics of the policy, including any limitations, exclusions, or requirements that may affect approval.

This verification helps identify potential hurdles, such as whether the service is considered medically necessary per the insurer’s criteria, if pre-existing conditions could influence coverage, or if there are specific procedures that must be followed to obtain authorization. By clearly communicating this information upfront, it allows both the patient and the provider to understand what is required to increase the likelihood of a good outcome, which facilitates better planning and decision-making regarding treatment options.

Other steps, while crucial in their own aspects, do not specifically inform about hurdles or requirements as directly as insurance verification does. Thus, this step is essential for ensuring that both the patient and provider move forward with a clear understanding of what to expect regarding insurance approval.