It is a process used by insurance companies to determine if a prescribed procedure, service, or medication is medically necessary before it is approved for coverage. Typically initiated by the healthcare provider, it requires submitting documentation to justify the treatment based on the patient’s diagnosis, medical history, and established clinical guidelines. Approval must be granted before the patient can proceed, or they may risk bearing the full cost. This process is essential for ensuring that treatments align with evidence-based practices and are not being used inappropriately or excessively. It also encourages providers to consider cost-effective alternatives before proceeding with expensive therapies or diagnostics.