Pre-approval in Health Insurance: Definition, When to Seek It, and Why It Is Required

Understanding pre-approval in health insurance is essential for navigating your healthcare journey smoothly. This process ensures you receive necessary treatments without unexpected financial burdens. 

Definition of Pre-approval 

Pre-approval, also known as pre-authorisation, is a process by which your insurance provider reviews and authorises certain medical services before they occur. This step is crucial to ensure that the services are covered under your specific policy. 

When Should I Seek Pre-approval? 

The need for pre-approval depends on your insurance provider and plan. It is generally required for high-cost services such as: 

• Hospitalisations

• Planned surgeries or treatments

• Diagnostic scans and tests (e.g., MRIs, CT scans) 

It is recommended to consult your policy details or contact your insurance provider to understand which services need authorisation. 

Why Is Pre-approval Mandatory (or Recommended)? 

There are several reasons why pre-approval is essential: 

• Direct Payment of Treatment Costs: this ensures that you don’t pay large sums out of pocket, as your insurer directly pays your treatment cost to the chosen medical facility.  

• Coverage Verification: your insurance provider will confirm that the requested treatment is included in your policy, preventing unexpected expenses. 

• Medical Necessity: this evaluates whether your treatment is medically necessary. This step helps prevent overprescription or non-essential treatments, particularly in private healthcare systems. 

• Best Medical Option: At APRIL, we go beyond basic checks. Our in-house team of doctors and nurses, along with our complimentary Second Medical Opinion service, assesses whether the recommended treatment is the best option for our members. We may suggest alternative treatments if they are more suitable. 

• Suitable Medical Provider: With over a decade of experience working with providers in Asia and beyond, we ensure that the chosen provider is appropriate for your treatment needs. 

• Reasonable and Customary Costs: this verifies that treatment costs are in line with market practices. At APRIL, we also negotiate directly with providers to ensure fair pricing. 

How Pre-approval Helps Keep Your Insurance Premiums Down 

The pre-approval process not only facilitates access to quality healthcare but also contributes to cost control. By avoiding unnecessary treatments and ensuring reasonable costs, insurers help maintain lower premiums year after year. 

How to Submit a Pre-approval Request with APRIL 

Pre-approval is mandatory for planned hospitalisations and treatments and typically needs to be sought 5 working days before the procedure, though this may vary by plan. After consulting their healthcare practitioners, members can submit their pre-approval requests through our Easy Claim app. They need to provide treatment details and attach any relevant medical documents. APRIL reviews these requests and, if the treatment is eligible, issues a guarantee of payment (called Letter of Guarantee) to the chosen medical facility. We can place Letters of Guarantee in most hospitals and clinics worldwide. 

Through our extensive market experience and strong relationships with medical providers, we strive to offer the best possible medical care while keeping your premiums manageable.