Which procedures need prior authorization in private insurance
In private health insurance, prior authorization is usually required for high-cost or high-coordination procedures: surgery and all ambulatory surgery, hospital admission, MRI, CT, PET-CT, scintigraphy, rehabilitation and physiotherapy in session blocks, psychotherapy, oncology and special treatments. The exact list varies by insurer and policy, so the clinic should measure it by insurer, procedure and site before confirming an appointment.
Short answer: expensive or complex procedures usually need authorization
In private health insurance, prior authorization usually appears in high-cost or high-coordination acts: surgery, hospitalization, MRI, CT, PET-CT, scintigraphy, rehabilitation, psychotherapy, oncology, endoscopy and special treatments.
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Diagnostic tests: MRI, CT, PET-CT and scintigraphy
ASISA states that CT, MRI, PET, scintigraphy, vascular/interventional radiology and nuclear medicine require authorization. MAPFRE distinguishes basic tests from non-routine diagnostic tests such as MRI and endoscopy.
Surgery and hospitalization: authorization before booking capacity
Surgery and hospitalization are sensitive cases. ASISA confirms that all surgery, including ambulatory surgery, needs prior authorization. Adeslas requires an exact date for admissions and interventions and a new request if that date changes.
Rehabilitation, physiotherapy and psychotherapy: the risk sits in renewals
Rehabilitation and physiotherapy often run in session blocks. The risk is not just the first referral; it is renewal timing, billing with the right authorization number and avoiding sessions outside the authorized window.
Oncology and special treatments: do not improvise with the portal open
ASISA includes all oncology treatments among services requiring authorization. MAPFRE mentions special cardiology and oncology treatments. The clinic needs clinical report, prescription, site, date and status clear before moving capacity.
Verified sources
- ASISA — Qué servicios tengo que autorizar — lista oficial de servicios con autorización
- ASISA — Cirugía ambulatoria y autorización previa — cirugía ambulatoria requiere autorización
- MAPFRE — Prestaciones que necesitan autorización — categorías de pruebas y tratamientos
- Adeslas — Autorizaciones — plazos por tipo de acto y tramitación en área cliente