Real answers for your healthcare questions
What is prior authorization and why does health insurance require it?
Answer
Prior authorization is a plan requirement to get approval before certain medications, tests, procedures, equipment, or services are covered. It is used to confirm that the requested service meets the plan's coverage rules.
What to Know
Approval does not guarantee that every cost will be paid, and lack of required authorization can lead to a denial. The doctor's office often submits the request, but the patient may still need to confirm that approval has been received before care is provided.
What to Do Next
If your doctor recommends a service, ask whether prior authorization is required and whether it has been approved. For urgent needs or a denial, ask the plan and provider about expedited review or appeal options.
Agent Perspectives
Be the first agent to share a perspective
Are you a licensed agent? Help clients with practical advice. Your name and profile appear with your answer.