A patient is preauthorized to receive vitamin B12 injections from Jan 1 to May 31. On June 2, the provider orders an additional 6 months of injections. In order for the patient to continue with coverage of care, which of the following should occur?

A patient is preauthorized to receive vitamin B12 injections from Jan 1 to May 31. On June 2, the provider orders an additional 6 months of injections. In order for the patient to continue with coverage of care, which of the following should occur?

• A. The provider should contact the patient's insurance carrier to obtain a new authorization
• B. The provider should continue injections without new authorization
• C. The patient should pay out-of-pocket until a new authorization is granted
• D. The service should be stopped

Answer: (A)

Preauthorization or prior authorization has a defined time frame. When the initial approval covers Jan 1 through May 31, continuing the same treatment beyond that window typically requires a new authorization to show ongoing medical necessity and to keep the service covered. So, the provider should contact the patient’s insurer to obtain a fresh authorization for the six-month extension. This helps ensure the injections remain covered and avoids billing the patient out of pocket or denying the claim. Continuing injections without a new authorization risks denial of coverage. Paying out-of-pocket could be an option in some cases but isn’t the preferred path when coverage renewal is possible. Stopping the service isn’t appropriate if there’s an ongoing medical need and a new authorization is being pursued.

Preauthorization or prior authorization has a defined time frame. When the initial approval covers Jan 1 through May 31, continuing the same treatment beyond that window typically requires a new authorization to show ongoing medical necessity and to keep the service covered. So, the provider should contact the patient’s insurer to obtain a fresh authorization for the six-month extension. This helps ensure the injections remain covered and avoids billing the patient out of pocket or denying the claim.

Continuing injections without a new authorization risks denial of coverage. Paying out-of-pocket could be an option in some cases but isn’t the preferred path when coverage renewal is possible. Stopping the service isn’t appropriate if there’s an ongoing medical need and a new authorization is being pursued.