We’re Updating Our Pre-Authorization Policy

We have updated our policy related to managing prior authorizations for elective surgical and diagnostic services. We want to make sure that clinicians and patients know when a procedure has not been authorized by the patient’s insurance provider and that there is a process in place to determine next steps.

What’s Changing

Beginning Wednesday, July 16:

For scheduled diagnostic procedures: If an elective procedure is not authorized by noon the day before the procedure, the referring office will be notified. The referring office will contact the patient to discuss next steps.

For scheduled surgeries: If the surgery is denied by the patient’s insurance provider or if there is a concern, the Pre-Access team will contact the referring office 2-3 days before surgery. If it is still not approved at noon the day before surgery, the surgeon’s office will be contacted to determine next steps.

For both: The new process and escalation steps are explained in the Prior Authorization Clearance Policy (PDF) and Prior Authorization Clearance Policy Job Aid (PDF).

Note that this process does not apply to the following procedures:

Emergency or Urgent Procedures
Same-Day STAT Procedures
Cancer-Related Surgeries
Infusion Services
Invasive Cardiac Procedures
Pulmonary Embolism Interventions
Nuclear Medicine / PET Scans
Venous Ultrasound Studies (DVT)

Why It Matters

This process will help reduce delays and last-minute changes to surgery by ensuring there is a process to escalate concerns. It will help patients avoid unexpected expenses when procedures are not authorized.