Prior authorization means your insurance company wants to approve certain care before you get it. Skip the step and they can refuse to pay — even for care your doctor ordered. It's one of the most frustrating parts of the system, so here's how to stay ahead of it.
Updated June 12, 2026
Expensive imaging (MRIs, CT scans), planned surgeries, specialty medications, medical equipment, and longer hospital stays are the usual suspects. Routine visits and emergencies don't need it — by law, emergency care never requires approval first.
Usually your doctor's office submits the request — but it's your bill if it doesn't happen. Before any planned procedure, ask two questions: 'Does this need prior authorization?' and 'Has it been approved yet?' Get the authorization number and keep it.
Denials get overturned more often than people think — but only if you appeal. Your denial letter has to explain why and how to appeal. Your doctor can often request a 'peer-to-peer' review, where they talk directly with the insurer's physician. Many denials are paperwork problems, not medical decisions.
Standard requests often take several business days; urgent requests are faster — plans are generally required to decide urgent cases quickly. If care is time-sensitive, make sure your doctor marks the request urgent.
It's strong but not absolute — the care still has to be covered by your plan and you still owe your normal share (deductible, coinsurance). But having the authorization number makes disputes much easier to win.
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