Ama Policy

Denials of Payment for Necessary Services Because of Lack of Authorization H-285.940

Retroactive Denial

1. Our AMA seeks the elimination of clauses in managed care contracts that allow plans to refuse to pay for provision of covered services for the sole reason that required notification of these services was not reported in a timely manner.

2. Our AMA supports a requirement that payers provide a retro-authorization process, with reasonable timeframes for submission and consideration and with reasonable procedural standards for all tests, procedures, treatments, medications and evaluations requiring authorization.

Policy Timeline

Sub. Res. 722, I-97 Reaffirmation A-02 Reaffirmation I-10 Appended: Res. 814, I-13