Prior authorization is advance approval from your insurer that a service is covered before you receive it. Without it, the plan may refuse to pay — even for care you needed.
A simple example
Your doctor recommends an MRI, and your insurer requires prior authorization. If the MRI is done before approval comes through, the claim can be denied — leaving you with the full bill.
Why it matters to you
Missing prior authorization is a leading cause of denied claims. A quick question before you schedule can save you a big, avoidable bill.
Good to know
- Ask your provider: “Does this need prior authorization, and has it been approved?” — before scheduling.
- For urgent situations, an expedited (faster) review can often be requested.
- If a claim is denied for missing authorization, you can usually appeal — many denials are overturned.
Definition: HealthCare.gov — Prior authorization; appeals: Appealing a health plan decision. See also In- vs out-of-network.
Educational use only. This content is general health and cost information — not medical advice, diagnosis, or treatment, and not financial, legal, or insurance-coverage advice. Specifics vary by plan and situation. Talk with a qualified clinician about your care and verify coverage with your insurer or provider. In an emergency, call 911.