Pre-Authorization Program

The need for quality medical care is evaluated for hospital admissions, outpatient surgeries, and specialized diagnostic studies.

When your physician determines that a hospital admission, outpatient surgery, or diagnostic procedure is necessary, Mapfre Life’s highly specialized and trained medical staff will validate the proposed treatment plan. Recommendations are based on scientific evidence, established medical guidelines, and the following factors:

Medical Necessity

The proposed treatment must be appropriate for you or your dependent based on the diagnosis provided.

Treatment Setting

The treatment location must be appropriate and provide cost-effective, high-quality care.

Appropriate Length of Stay

Hospital stays should be neither longer nor shorter than medically necessary according to current medical guidelines.

Proposed Treatment Plan

Your physician must recommend the medical or surgical treatment that best aligns with your diagnosis.

Does Every Mapfre Life Policyholder Require Preauthorization?

No. Not all insured members are subject to preauthorization reviews for medical procedures. You should verify whether your specific policy coverage requires preauthorization or precertification.

The process begins with a call to Customer Service, where you can confirm whether your procedure requires authorization and receive instructions on how to proceed.

Why Is Preauthorization Required?

Preauthorization helps determine whether your medical need involves a hospital admission, outpatient surgery, or diagnostic procedure that may not be covered under your policy.

For assistance, contact:

• 787 622 7780
• 1-800-981-3271 (Puerto Rico)

You can also request your medical pre-authorization through the Mis Seguros app.