What is the procedure for pre-authorization of medical services?

The procedure for pre-authorization of medical services with Great West Health generally involves several key steps designed to ensure that the proposed services are medically necessary and eligible for coverage. First, the healthcare provider typically initiates the pre-authorization request on behalf of the patient. This process often requires the provider to provide detailed information about the patient's condition, the specific services needed, and sometimes even supporting documentation, such as medical records or test results. Once the pre-authorization request is submitted, Great West Health reviews the information to determine if the requested services meet their guidelines and criteria for medical necessity. This review process can vary in duration depending on the complexity of the case and the specific services being requested. The patient and their healthcare provider are usually informed of the decision once it is made. If the pre-authorization is granted, the patient can proceed with the scheduled services with confidence that their insurance coverage will apply. If the request is denied, the provider and the patient are informed of the reasons for the denial, and there may be options for appeal or further discussion with Great West Health regarding the decision. To obtain the most accurate and specific information regarding pre-authorization procedures, it is advisable to review the member resources available on the Great West Health website.