Question

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

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

Answer 1

The term for the requirement that a physician gets health plan approval for a procedure or medication is 'prior authorization'. It ensures treatments are medically necessary and covered by insurance.

Step-by-step explanation:

The term for a requirement that a physician obtain approval from a health plan to perform a specific procedure or prescribe a specific medication is prior authorization. This process is used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication. The purpose is to ensure that the proposed treatment is medically necessary and falls within the standards of acceptable medical practice. Without prior authorization, the insurance may not provide coverage for the treatment, leaving the patient responsible for the full cost.