AAMA CMA Practice Question

Securing prior authorization is essential for non-urgent, potentially high-cost services because insurance companies typically require this step to approve the medical necessity of the service and determine coverage under the patient's health plan. If prior authorization is not obtained when required, the insurance provider may deny payment, which can result in financial responsibility being transferred to the patient and revenue loss for the healthcare provider. Verifying only the patient's eligibility for coverage does not ensure that the scheduled service will be covered. Confirming the appointment without insurance verification may lead to last-minute cancellations or financial complications. Delaying the insurance verification process until the patient arrives for the procedure can lead to postponed services and a suboptimal patient experience.