Good news can go sideways fast when the medical service or therapy your child needs is slowed down by red tape. It starts when you hear the approval from Medicaid won’t happen without a Prior Authorization (PA). But don’t worry! We have the information on PAs that you need to smooth out this process.
A PA is an approval process used by health plans and Medicaid to decide if a service or treatment will be covered. Medicaid approves PA requests based on their decision that the treatment or service is medically necessary for your child.
While it’s up to the provider to complete this paperwork, you can be actively involved in the process. You can start by making sure the PA request includes any information that you think is useful, and that it gives a complete picture of why the service or treatment is medically necessary for your child.
Families can:
Also, if the PA is sent back or is denied, you can work with your child’s provider to re-submit the PA with more details.
To learn more see our Family Voices Fact Sheet, Insurance Prior Authorizations.
