Prior Authorization Explained

What prior auth is for

Prior authorization is a plan's review step before it agrees to cover certain drugs, imaging, or procedures. The aim is to confirm medical necessity and appropriate use.

It can delay care if paperwork is slow — start early when your clinician recommends a service that commonly needs approval.

How to reduce friction

Ask the clinic who submits the prior auth and how long it usually takes. Keep documentation of medical need. If denied, ask about appeals and alternative covered options.

When comparing plans, look at how aggressively they use prior authorization for the therapies you already use.

Frequently asked questions

Is an emergency subject to prior authorization?

Emergency care is handled differently; do not delay emergency treatment to seek authorization.

What if prior auth is denied?

You and your clinician can usually appeal. Ask the plan for the denial reason in writing.