Does obtaining a prior authorization from a patient's plan obligate the plan to pay for that treatment ?

Section 1371.8 of the California Health and Safety Code and Section 796.04 of the Insurance Code state that a health plan which has provided a prior authorization for specific treatment by a health care provider shall not rescind or modify the authorization after the care has been rendered by the provider in good faith and where the treatment is consistent with what was preauthorized. If a patient has fallen out of eligibility for coverage prior to the treatment, the plan or insurance company is no longer obligated to pay for the authorized treatment.

Dental CPT Code Lookup.

About Us | Contact | Privacy

Copyright 2021 - ©