Get ready for your visit and know what to ask.

When you hear the words “prior authorization,” here’s what to know.

For some medications, your doctor may need to get approval from your insurance provider before the prescription can be filled. This is also known as a “prior authorization.”

Without this approval, your insurance plan may not pay for your medication.

Why do some medications or procedures require prior authorization?

Health insurance companies have long used prior authorization as a way to control their costs. Without prior authorization, your insurance plan may not pay for your medication, and you would be responsible for the full cost.

What is prior authorization?

Prior authorization (also called “preapproval” or “precertification”) is what your health insurance company sometimes requires in order to approve coverage for certain medications or procedures before they are prescribed. It’s essentially your healthcare provider claiming that the care they prescribed is medically necessary.

What happens if my prior authorization request is denied?

Don’t worry, you have options. Sometimes even simple clerical errors can affect a request. So, the first best step is to find out why. Your healthcare provider should be able to help. You and your provider may choose to appeal the decision if you think the denial was not justified.

How long does the prior authorization process take?

Currently, prior authorizations are processed within 5 to 10 days. For some medications, it can take up to 30 days. For urgent requests, prior authorizations can be processed within 72 hours.