Can I get retroactive prior authorization?

Some insurers allow retroactive authorization in limited circumstances, such as emergencies. Contact your insurer as soon as possible after the service to request it. The longer you wait, the less likely approval becomes.

How long does prior authorization take?

Non-urgent requests typically take 3 to 15 business days. Urgent requests must be processed within 24 to 72 hours under federal guidelines. Some states have stricter timelines.

Prior Authorization Explained: Why Insurance Makes You Wait

What Is Prior Authorization?

Prior authorization (also called pre-authorization, pre-cert, or prior approval) is a requirement by your insurance company to approve a medical service before it is performed. The insurer reviews the request to determine whether the procedure, medication, or test is medically necessary under your plan. Without prior authorization for services that require it, your insurance may deny the claim entirely, leaving you responsible for the full cost.

Which Services Require Prior Authorization?

Common services requiring prior authorization include advanced imaging (MRI, CT, PET scans), non-emergency surgery, specialty medications, durable medical equipment, physical therapy beyond a set number of sessions, mental health treatment, and out-of-network referrals. The specific requirements vary by insurance plan. Your plan documents or member portal will list which services need prior approval. When in doubt, call the number on your insurance card before scheduling.

How the Prior Authorization Process Works

Your doctor submits a request to your insurance company with clinical documentation supporting the medical necessity of the service. The insurer reviews the request — usually within 3 to 15 business days for non-urgent cases, or within 24 to 72 hours for urgent requests. The insurer then approves, denies, or requests additional information. An approval is valid for a limited time (usually 30 to 90 days), so schedule your service promptly.

What to Do If Prior Authorization Is Denied

If denied, you have the right to appeal. Ask the insurer for the specific reason code and clinical criteria they used. Your doctor can submit a peer-to-peer review, where they speak directly with the insurance company's medical reviewer to argue for medical necessity. If the internal appeal fails, you can request an external review by an independent third party. Federal law requires insurers to cover the cost of this external review.

How Prior Authorization Affects Your Bill

If a service is performed without required prior authorization, the insurer may deny the claim retroactively. In that case, the provider may bill you for the full amount. Always confirm authorization status before your appointment. If your provider says they handle prior auth, ask for the authorization number and verify it with your insurer directly.