CARD Q069
A health plan approves a requested service in advance. What does prior authorization alone establish?
- The plan has guaranteed payment regardless of the services actually billed
- That the plan’s advance-review requirement has been met
- The service will be paid without applying the deductible
- The requested service is covered even if membership ends before treatment
That the plan’s advance-review requirement has been met
Authorization is not a blanket payment guarantee. Eligibility, actual services, exclusions, and other policy terms still matter.
Why each choice is right or wrong
A. The plan has guaranteed payment regardless of the services actually billed
Incorrect. Authorization does not guarantee payment for services different from those approved or otherwise ineligible.
B. That the plan’s advance-review requirement has been met
Correct. Authorization is not a blanket payment guarantee. Eligibility, actual services, exclusions, and other policy terms still matter.
C. The service will be paid without applying the deductible
Incorrect. Deductibles can still apply.
D. The requested service is covered even if membership ends before treatment
Incorrect. Eligibility at the time of service still matters.
Review the related terms
Use these lessons to revisit the concepts and try additional practice questions.