Do I Need Pre-Approval? Quick Decision Guide
Pre-approval ensures your treatment is covered before you receive it, avoiding unexpected costs and claim rejections. Use this quick guide to determine if you need pre-approval for your medical service.
Quick Decision Tree
Is it a medical emergency?
- ✓ YES → Go to hospital immediately, approval within 48 hours
- ✗ NO → Continue to next question
Is it a routine consultation?
- ✓ YES → No pre-approval needed
- ✗ NO → Check the lists below
ALWAYS Require Pre-Approval
Hospital Services
- ☑ All planned hospital admissions
- ☑ Day surgery procedures
- ☑ Overnight observations
- ☑ Chemotherapy sessions
- ☑ Dialysis treatment
- ☑ Radiation therapy
Advanced Diagnostics
- ☑ MRI scans
- ☑ CT scans
- ☑ PET scans
- ☑ Cardiac catheterization
- ☑ Endoscopy/Colonoscopy
- ☑ Sleep studies
Specialized Treatments
- ☑ Physiotherapy sessions
- ☑ Home healthcare
- ☑ Speech therapy
- ☑ Psychiatric consultations
- ☑ Psychology sessions
- ☑ Alternative medicine
NEVER Need Pre-Approval
Basic Outpatient Services
- ✓ GP consultations
- ✓ Specialist visits (if direct access allowed)
- ✓ Basic blood tests
- ✓ X-rays
- ✓ Ultrasounds (non-maternity)
- ✓ ECG
- ✓ Prescribed medicines (within limit)
Emergency Services
- ✓ Emergency room visits (notify within 48 hours)
- ✓ Ambulance for emergencies
- ✓ Emergency dental pain relief
- ✓ Urgent care for accidents
Pre-Approval by Specialty
| Specialty | Usually Need Approval | No Approval Needed |
|---|---|---|
| Maternity | Delivery, C-section, High-risk procedures | Routine prenatal visits, Basic ultrasounds |
| Dental | Crowns, Bridges, Root canals, Braces | Cleaning, Filling, Extraction, X-rays |
| Optical | Surgery (LASIK), Special lenses | Eye exams, Standard frames/lenses |
| Orthopedic | Surgery, Joint replacement, Arthroscopy | Consultation, X-rays, Cast application |
| Cardiac | Angiography, Stents, Pacemaker, Surgery | ECG, Echo, Consultation, Stress test |
Amount-Based Triggers
Pre-approval often required when treatment costs exceed:
- Outpatient procedures: AED 1,000-3,000 (varies by plan)
- Diagnostic tests: AED 1,500
- Dental work: AED 1,000
- Medications: AED 500 per prescription
How to Request Pre-Approval
Fastest Method: Provider Initiated
- Doctor/hospital contacts insurance directly
- Medical reports submitted electronically
- Approval received in 2-48 hours
- You get SMS confirmation
Self-Service Options
Via Mobile App:
- Open myNAS/myNeuron app
- Select "Pre-Approval Request"
- Upload prescription/medical report
- Submit and track status
Via Phone:
- Call 24/7 helpline
- Provide treatment details
- Email supporting documents
- Receive reference number
Approval Timelines
| Service Type | Standard Timeline | Urgent Cases |
|---|---|---|
| Diagnostic tests | 4-6 hours | 2 hours |
| Elective surgery | 24-48 hours | Same day |
| Physiotherapy | 24 hours | 4 hours |
| Home healthcare | 48 hours | 24 hours |
| International treatment | 5 working days | 48 hours |
What Information is Needed?
Have ready:
- ✓ Member ID and insurance details
- ✓ Doctor's prescription/recommendation
- ✓ Medical reports supporting treatment
- ✓ Cost estimate from provider
- ✓ Previous related medical history
Common Approval Scenarios
Scenario 1: MRI for Back Pain
- ✓ Pre-approval REQUIRED
- Doctor must justify medical necessity
- Usually approved within 4-6 hours
- Alternative tests may be suggested first
Scenario 2: Dental Crown
- ✓ Pre-approval REQUIRED
- X-rays and treatment plan needed
- Cost estimate must be submitted
- Approval includes lab fees
Scenario 3: Emergency Appendectomy
- ✗ Pre-approval NOT needed
- Proceed with emergency surgery
- Hospital notifies insurance within 48 hours
- Retroactive approval processed
If Pre-Approval is Denied
Don't panic. Common reasons and solutions:
| Denial Reason | What to Do |
|---|---|
| Not medically necessary | Get second opinion, provide more documentation |
| Service not covered | Check policy, discuss alternatives with doctor |
| Limit exceeded | Check remaining benefits, consider next policy year |
| Waiting period active | Confirm dates, wait or pay out-of-pocket |
| Documentation incomplete | Submit missing documents immediately |
Golden Rules
- When in doubt, call and check - Better safe than sorry
- Emergency first, paperwork later - Never delay emergency care
- Let providers handle it - They're experienced with the process
- Keep approval numbers - Save SMS and email confirmations
- Approvals expire - Use within validity period (usually 14 days)
Quick Reference Card
Save this for easy reference:
- Hospital admission? → YES, need approval
- Surgery? → YES, need approval
- MRI/CT/PET? → YES, need approval
- Regular doctor visit? → NO approval needed
- Blood test/X-ray? → NO approval needed
- Emergency? → NO prior approval (notify within 48hrs)
- Cost over AED 3,000? → Probably YES
- Not sure? → Call helpline!
Remember: Pre-approval protects you from unexpected costs and ensures smooth treatment. When your doctor recommends any significant treatment, always ask: "Does this need insurance pre-approval?" They'll guide you through the process.