Why might an insurer deny a claim submitted by a specialist with a preauthorization?

A claim submitted by a specialist with a preauthorization can be denied if the service was provided after the expiration date of the preauthorization. Preauthorizations are time-sensitive approvals granted by insurers for specific treatments or procedures, allowing healthcare providers to deliver those services to patients while ensuring that the insurer agrees to cover the costs.

If the service is performed after the expiration date, the insurer may consider the authorization as invalid, even though it was initially approved. This ensures that the insurer only covers services that are deemed necessary and relevant within a certain timeframe. In this case, even though preauthorization was obtained, the timing of the service is critical for the validity of the claim.

While other options could potentially lead to a claim denial, they do not directly pertain to the conditions of the preauthorization itself. For example, a late submission may reflect administrative inefficiencies but does not relate to preauthorization timing; a noncovered service pertains to the specific codes for which the insurer provides coverage, rather than the preauthorization process; and a missed appointment indicates patient compliance issues rather than procedural eligibility under preauthorization guidelines.