Getting the yes before the care.

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Confirm whether prior auth is even required You · 1 call

Not everything needs approval — it's typically imaging (MRI/CT), surgeries, hospital stays, specialty medications, and certain therapies. Call the member services number on your insurance card:

Say this"My doctor has ordered [service / medication]. Does my plan require prior authorization for this? If yes, can you note this call — and what's the reference number?"

Write down the date, the rep's name, and the reference number. If they say no auth is needed, that recorded call is gold if anything gets denied later.

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Make sure the office actually submits it Doctor's office

The ordering provider's office submits the request with clinical notes justifying why it's medically necessary. Your move is one short call to their office:

Say this"Has the prior authorization for my [service] been submitted yet? What date did it go in, and can I get the authorization request or tracking number?"

If it hasn't gone in and your date is near, politely push — auth turnaround eats calendar days, and offices juggle hundreds of these.

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Track it until there's a decision You · every few days

Standard decisions typically take up to ~15 days; urgent requests are faster (about 72 hours) when the doctor marks them urgent. Don't assume silence means progress:

• Check your insurance portal — many show auth status under "Prior Authorizations" or "Referrals."
• Every few days, one call: "Status on prior auth for [service], reference #___?"
• If insurance says they're "waiting on records," immediately call the doctor's office and tell them exactly what's missing. This gap — each side waiting on the other — is where most delays live, and you're the only person who can see both sides.
• Care scheduled and still no decision? Ask the doctor's office to mark it urgent or request an expedited review.

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Approved — lock down two details You · 2 minutes

Get the authorization number and keep it with you on the day of care. Then verify the approval actually matches the plan:

• Right procedure/medication, right provider, right facility — an auth approved for one location doesn't automatically cover another.
• Check the expiration date. Auths are approved for a window (often 60–90 days). If care gets rescheduled past it, the auth must be renewed — this catches people constantly.

Worth knowingAn approval isn't a payment guarantee — the claim still processes through your deductible and coinsurance afterward. The approval just means the plan agrees the care is covered and necessary.

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Denied — work the ladder You + doctor together

Prior auth denials get reversed all the time. The ladder, in order:

• Get the denial reason in writing. "Not medically necessary," "try a cheaper option first" (step therapy), or "missing information" each have different fixes.
• Missing info? The easiest win — the office resubmits with complete records.
• Ask your doctor to request a peer-to-peer review — your doctor speaks directly with the insurance company's physician. Denials frequently flip on this single call.
• Step therapy denial? If you've already tried the cheaper drug (even on a previous plan), your doctor can document that and request an exception.
• Still denied? File a formal appeal. It's your legal right, deadlines are typically 180 days, and appeals win often enough that not appealing is the real mistake.