Frequently Asked Questions About the Prior Authorization

What is a pre-authorization?

Pre-authorization is a written confirmation from the insurer that outlines the costs and eligibility for reimbursement. This confirmation is provided after you submit your application to MSH and before you receive specific medical treatment. 

Prior authorization lets you know whether:

1. Your insurance plan covers your treatment

2. There are co-payments, deductibles, and limitations that may apply to your treatment

3. There is a more suitable hospital or specialist for your treatment

Which treatments and procedures require prior authorization?

All hospitalizations, including childbirth

Outpatient surgery requiring general anesthesia, as well as  chemotherapy, radiation therapy, hemodialysis, and peritoneal dialysis

Emergency Medical Evacuation

Prior authorization is required. If evacuation is arranged without it, the insured person will be responsible for the costs incurred.

Purchase or rental of Durable Medical Equipment (DME), which includes items such as insulin pumps and supplies

Home Nursing Care

Emergency Dental Treatment (excluding immediate pain relief)

Medications or immunizations costing more than CNY 8,000 per refill

Therapeutic services requiring ten or more sessions in the same policy year

Does the result of the pre-authorization decide if medical expenses will be reimbursed?

Pre-authorization does not guarantee coverage of treatment costs. It indicates that the treatment plan meets clinical necessity criteria and provides a preliminary assessment of benefits. The final decision on coverage will be made during the claims assessment, based on the insurance policy. 

If the submitted medical records and invoices differ from the pre-authorization information, the coverage may change.