Who Really Decides Your Care? Inside Prior Authorization and Insurance Denials | CJN Network

A patient presents with severe back pain. Their physician recommends an MRI to rule out a serious spinal condition.

But before the imaging can be performed, the insurance company requires prior authorization.

The request is submitted with clinical documentation explaining why the test is necessary. Days later, the response comes back: Denied.

Instead of approving the MRI, the insurer requires six weeks of physical therapy first.

The physician believes imaging is necessary. The patient remains in pain. And the test cannot move forward unless the insurance company agrees to pay for it.

Situations like this raise an important question:
Who actually made the decision about that care?

Episode 4 of CJN Network explains how prior authorization works, how insurers define medical necessity, and why coverage decisions are often mistaken for medical decisions.

Watch the full episode now on CJN Network.

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Видео Who Really Decides Your Care? Inside Prior Authorization and Insurance Denials | CJN Network канала Cambria Nwosu, DNP, RN, LNC