What is required for elective hospitalization under a managed care plan before claims are paid?

Pre-authorization approval is a crucial requirement for elective hospitalization under a managed care plan. This process involves the insured obtaining approval from the managed care organization before undergoing elective procedures or treatments. The primary purpose of pre-authorization is to ensure that the planned hospitalization is medically necessary and covered under the insured's health plan. It also helps manage costs by reviewing the necessity and appropriateness of the procedure beforehand.

If pre-authorization is not obtained, there is a significant risk that the insurance company may deny the claim once it is submitted, leaving the patient responsible for the costs. By requiring pre-authorization, managed care plans can control expenditures and ensure that care aligns with established medical guidelines.

The other options—post-authorization approval, claim submission within 30 days, and secondary review by a physician—do not represent the standard practice of obtaining necessary approval before scheduling elective procedures. Post-authorization typically occurs after a service has been rendered, while timely claim submission relates to how quickly a provider must file a claim, and secondary reviews may happen in specific circumstances but are not a prerequisite for elective hospitalization in managed care.