How prior authorization works

Prior authorization (PA) is your insurer's permission slip before certain services are performed. Here is how the process usually flows.

Who submits it

Your provider's office or the facility submits the request — not you. They send clinical information to the insurer, who reviews it against their policy criteria.

How long it takes

Standard reviews are usually 5–15 business days. Urgent reviews are typically 72 hours or less. Pharmacy PAs may be faster. Ask your provider to confirm the submission date and to flag it as urgent if it is.

What to ask before your appointment

Ask whether a PA is required, whether it has been submitted, and whether it has been approved — in writing — before the service date. "It's pending" is not the same as "approved."

If it is denied

You can appeal. Ask the insurer in writing for the policy criteria they applied. Ask your provider to write a letter of medical necessity addressing those exact criteria. Most plans offer internal appeals, and many states also offer external review by an independent organization.

Related glossary term: Prior Authorization — Some services may need plan approval before they are performed.