What is pre-authorisation in health insurance?
Pre-authorisation is one of the simplest levers a health insurer has to protect its loss ratio. It is also one of the most commonly wasted.
Pre-authorisation, sometimes called prior authorisation, is the approval a health insurer gives before a service is delivered. In principle it is a control point: a chance to confirm that a member is covered, that the service is appropriate, and that the provider is in network, before the cost is committed.
In practice, whether it actually protects margin comes down to one thing: when the decision is made.
Real-time versus retrospective
A retrospective review looks at spend after it has happened. By then the care has been delivered and the cost is committed, so the only thing left to do is reconcile it. It can tell you what you spent. It cannot change it.
A real-time decision happens while the care decision is still open. The insurer can approve, route, or query the request before anything is committed. Same control point, completely different outcome.
Retrospective authorisation turns a report you read into a decision you never got to make.
Why it protects the loss ratio
The loss ratio, the share of premium paid back out in claims, is decided by thousands of small choices made while each claim is still in front of you. Real-time pre-authorisation is one of the earliest of those choices. Resolve coverage before the service, steer the member to an appropriate in-network provider, and you have controlled cost at the point where control is still possible, rather than clawing it back afterwards.
Built for how members actually reach you
In a Nigerian and wider African context, pre-authorisation only works if it meets members and providers on the channels they already use. That means WhatsApp-first engagement, with SMS and USSD support, so a member on a feature phone is never left out of a decision that affects their care.
This is exactly how pre-authorisation and provider steering on Ajé is built: real-time decisions at the point of care, on the same member and claims model as the rest of the platform, so an authorisation made today is visible when the claim arrives later. For the bigger picture on how these decisions move the number, see how Nigerian health insurers protect their loss ratio.
See real-time pre-authorisation on your workflows.
We walk through authorisation and provider steering against the cases your team handles every day.