Prior authorization (also called preauthorization or pre-approval) is a requirement that your doctor or health care provider get approval from your insurance company before delivering certain services, procedures, or medications. Without it, your insurer may deny the claim and you could be responsible for the full cost.
Services that commonly require prior authorization include:
Prior authorization is your insurer’s way of reviewing medical necessity before paying. It does not guarantee payment — a claim can still be denied after authorization if the service is billed differently than approved. If authorization is denied, you have the right to appeal.
Emergency care never requires prior authorization. Federal law requires insurers to cover emergency services without prior approval. For non-emergency care, your provider’s office typically handles the authorization request on your behalf — but it’s worth confirming the request was submitted before your appointment.
Yes. If prior authorization is denied, you can appeal the decision through your insurer’s internal appeals process. If the internal appeal is unsuccessful, you have the right to an independent external review. Your doctor can also submit additional clinical documentation to support the necessity of the service during the appeal.
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