Question

What is a requirement that a physician obtain approval from a health plan to receive a specific procedure or prescribe a specific medication called?

a) Pre-authorization
b) Immediate treatment
c) Expedited care
d) Direct referral

Answer 1

The requirement for a physician to obtain health plan approval before a specific medical procedure or prescription is known as pre-authorization. It ensures that the insurance will cover the costs of the procedures, services, or medications.

Step-by-step explanation:

The requirement that a physician must obtain approval from a health plan to proceed with a specific procedure or prescribe a specific medication is called pre-authorization. This is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication. Pre-authorization is not the same as immediate treatment, which refers to urgent or emergency care that requires prompt attention. It is also different from expedited care, which can be speeded up due to the patient's condition and direct referral, which is a physician's recommendation for a patient to see a specialist.