Examlex
Which of the following statements is CORRECT?
Preauthorization
Prior approval of insurance coverage and necessity of procedure; refers to obtaining plan approval for services prior to the patient receiving them; relates not only to whether the services are covered but also whether the proposed treatment is medically necessary.
Medically Necessary
A term used to describe treatments, services, or supplies needed to diagnose or treat a medical condition, determined by healthcare providers.
Indemnity-Type Insurance
A form of insurance where the insurer compensates the insured for losses in exchange for premiums paid, without providing the service directly.
Referral for Patient Care
The process by which a healthcare provider sends a patient to another specialist or service for further examination or treatment.
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