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From NPR.

Hey, it's Mariel.

When you go to the doctor and have a procedure done, the doctor's office will submit a claim to your insurance. And then the insurance company will say, this service is covered or not covered.

Here's how much we'll pay for it.

Here's how much the patient is going to pay.

In some cases, though, that analysis has to happen before your procedure or tests.

It requires what's called a prior authorization.

And this is for a couple reasons.

Sarah Bowden is a health care reporter.

She's been looking into this for the KFF Health

News and NPR project called Healthcare Helpline. One, you know, as a patient, you don't want to

get slammed with a big medical bill that you thought was going to get covered, but it's not. Also,

doctors don't want the same thing. They don't want to be left holding the bag because their patient

can't pay and the insurance company can't pay. Also, insurance companies argue requiring prior authorizations

prevents waste, fraud, and abuse because they're looking to see if somebody actually needs

medical care before it's delivered. But what triggers prior authorizations?

That's not totally clear.

It's another part of the health insurance industry that's a bit of a black box.

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