Michigan Association of Health Plans

What is prior authorization?

What is prior authorization? Prior authorization is a collaborative utilization management process used by health insurance carriers to determine if a prescribed procedure, service, or medication will be reimbursed under the health insurance plan. Utilization management programs are a “check and balance” to ensure the care delivered is in the right place and time for the patient, and is cost-effective.

Why is it important? Prior authorization is important for a number of reasons.

  1. Prior authorization is a matter of safety. Prior authorization ensures that the service or drug you’re requesting is truly medically indicated.
  2. Prior authorization helps keep costs down. Prior authorization helps manage costs by ensuring that patients receive safe, effective medical treatment that is the most valuable to the individual and their medical condition.
  3. Prior authorization is the “checks and balances” of health care. Prior authorization helps ensure that waste, error, and unnecessary prescription drug use are minimized.

 The Michigan Legislature is currently voting on whether or not prior authorization should be functionally eliminated in Michigan. Keep costly mandates out of your healthcare—and keep premiums down. Tell your legislator to vote NO on Senate Bill 612.

Find your legislator here.

Contact Sen. VanderWall at 517-373-1725 or [email protected].

Contact Sen. Bizon at (517) 373-2426 [email protected]

Contact Sen. Brinks at 517-373-1801 or [email protected].

Contact Sen. Johnson at (517) 373-1636 or [email protected]

Contact Sen. LaSata at (517) 373-6960 or [email protected]

Contact Sen. MacDonald at 517-373-7315 or [email protected].

Contact Sen. Theis at (517) 373-2420 or [email protected]

Contact Sen. Hertel at 517-373-1734 or  [email protected].

Contact Sen. Santana at 517-373-0990 or [email protected].

Contact Sen. Wojno at 517-373-8360 or [email protected].

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