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Managed care plans typically require the permission of the primary care physician, the pcp, before a patient visits an emergency room to control costs and ensure that care is medically necessary.
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The primary reasons for this requirement are one, cost control.
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Emergency room visits are significantly more expensive than visits to a primary care physician or urgent care center.
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By requiring prior authorization, managed care plans aim to reduce unnecessary er visits and manage health care costs more effectively.
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Two, coordination of care.
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The pcp acts as a gatekeeper who coordinates all aspects of the patient's health care.
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This ensures that the patient receives appropriate and continuous care.
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And that all medical records are centralized with the pcp.
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Three, medical necessity.
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The pcp can determine whether the symptoms truly warrant an emergency room visit or if they can be managed through less costly and more appropriate means, such as an office visit or urgent care visit.
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Circumstances, when permission is not required.
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There are, of course, situations where prior authorization from the pcp is not required for an emergency room visit because it may not be practical to get that prior authorization...