US Medical Term · insurance
Prospective Review
Revisión prospectiva
In 9 languages
| Language | Term |
|---|---|
| English | Prospective Review |
| Spanish (Español) | Revisión prospectiva |
| Chinese (中文) | 前瞻性審查 |
| Korean (한국어) | 사전 검토 |
| Vietnamese (Tiếng Việt) | Đánh giá tiền cứu |
| Filipino (Tagalog) | Prospective na pagsusuri |
| Portuguese (Português) | Revisão prospectiva |
| Thai (ภาษาไทย) | การทบทวนล่วงหน้า |
| Japanese (日本語) | 事前審査 |
What it means
Prospective review is a type of utilization review performed before a planned medical service or treatment takes place. This is the same process as prior authorization — the insurer evaluates whether a requested service is medically necessary and meets plan criteria before it is approved for coverage. Prospective review is commonly required for elective surgeries, specialty procedures, certain prescription drugs, inpatient admissions, and rehabilitation services. The goal is to prevent unnecessary or inappropriate care and control costs before expenses are incurred. Approval from a prospective review does not guarantee full payment; the insurer may still review the final claim to ensure the service provided matched what was approved.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
Has the prospective review been completed and approved for my upcoming surgery?
¿Se ha completado y aprobado la revisión prospectiva para mi cirugía próxima?
What information does my doctor need to submit for the prospective review?
¿Qué información necesita enviar mi médico para la revisión prospectiva?
How long does the prospective review decision typically take?
¿Cuánto tiempo suele tardar la decisión de la revisión prospectiva?
Where you'll see it
Related terms
Sources
Last reviewed: September 2026