📝 Prior Authorization

Prior authorization — the requirement to get insurer approval before receiving care — causes treatment delays and denials that harm patients. These guides explain when auth is required, how to get it approved, and what to do when it's denied.

93% · of physicians say prior auth delays necessary care

Featured Guides

Prior Authorization for Medication: How to Get Approved (2026)

Learn how prior authorization for medication works, which drugs require PA, what to do when denied, and how new 2026 CMS rules limit Medicare Advantage delays.

Read guide →

All Prior Authorization Guides (1)

2026-04-05

Prior Authorization for Medication: How to Get Approved (2026)

Learn how prior authorization for medication works, which drugs require PA, what to do when denied, and how new 2026 CMS rules limit Medicare Advantage delays.

Frequently Asked Questions

What is prior authorization?

Prior authorization (PA) is your insurer's requirement to approve certain procedures, medications, or specialist visits before you receive them. Without approval, the claim may be denied. PAs are most common for specialty drugs, imaging, surgery, and mental health services.

How long does prior authorization take?

Standard PA requests must be decided within 15 days under federal rules (or 72 hours for urgent cases). Many states have faster requirements. If your insurer takes longer, escalate to your HR department or state insurance commissioner.

What do I do if prior authorization is denied?

Request the specific denial reason and clinical criteria in writing. Your doctor can submit a peer-to-peer review (doctor calls the insurer's medical director directly) — this reverses roughly 50% of denials. If that fails, file a formal appeal.