Common use of Prior Approval Does Not Guarantee Benefits Clause in Contracts

Prior Approval Does Not Guarantee Benefits. The fact that TPA authorizes services or supplies does not guarantee that all charges will be covered. TPA reserves the rights to review each claim if there are questions regarding Medical Necessity. Under these circumstances, Coverage of some health care services and supplies may be denied. Covered Persons will be notified in writing of any subsequent adjustment of Benefits as a result of the claim review.

Prior Approval Does Not Guarantee Benefits. The fact that TPA authorizes services or supplies does not guarantee that all charges will be covered. TPA reserves the rights right to review each claim if there are questions regarding Medical Necessity. Under these circumstances, Coverage of some health care services and supplies may be denied. Covered Persons will be notified in writing of any subsequent adjustment of Benefits as a result of the claim review.