Pre-Authorisation Delays: How Hospitals Lose Admissions and Revenue
Map where your cashless pre-auth requests stall and set up a process that gets approvals back before patients walk out.
A patient arrives for a planned surgery with a valid policy. The insurance desk sends the pre-auth request, the TPA asks for an earlier consultation note, and the request sits overnight because the treating doctor is in theatre. The patient's family gets anxious, asks about paying cash, and some decide to try another hospital.
Insurance desks often run on email inboxes, portal logins and phone calls, with no single view of which requests are pending and why. Queries arrive in different formats from different TPAs. When the desk changes shift, half the context goes with the person who left, and nobody knows which approval is about to miss the admission window.
Why do TPAs raise so many pre-auth queries?
Usually because the first request lacks something they need to assess medical necessity or cost, such as investigation reports, a clear diagnosis or a justified estimate. A complete standard pack per procedure removes many of these queries.
Should we admit the patient while pre-auth is pending?
For emergencies, treat first and follow your hospital's emergency pre-auth process. For planned cases, many hospitals admit on a deposit while approval is pending. Agree the policy with finance and explain it clearly to patients.
Who should own pre-auth on the hospital side?
A named insurance desk lead should own the queue, with each request and query assigned to a specific person. The treating doctor's team owns clinical inputs. Shared ownership with no names is where requests stall.