Direct answer
No, prior authorization only confirms that a service is medically necessary according to your plan’s criteria; it does not guarantee final payment, which still depends on your specific benefits and eligibility at the time of service.
Standard health insurance provider policy documents and member handbook guidelines. For additional information about how coverage determinations and appeals work, see the Centers for Medicare & Medicaid Services.
What this means for you
No, prior authorization only confirms that a service is medically necessary according to your plan’s criteria; it does not guarantee final payment, which still depends on your specific benefits and eligibility at the time of service.
FARMER STOCKMAN
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This page is informational and not a coverage guarantee or quote.
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