Why it matters
Getting care without required prior authorization can mean the plan denies the claim, leaving the patient responsible for the full cost.
GetFastRates.com
Prior Authorization
Prior authorization is approval a health plan requires before it will cover certain services, procedures, or medications.
Example
Some MRIs, specialty medications, and non-emergency surgeries commonly require prior authorization before a plan will cover them.
Common mistake
A common mistake is assuming a doctor's office automatically handles prior authorization -- it's worth confirming it was submitted and approved before the appointment or procedure.
Quick comparison
| Topic | Prior Authorization |
|---|---|
| Coverage area | health |
| Best next step | Review how this term applies to your plan, state, timing, and coverage question. |
Questions about Prior Authorization
Why should I understand Prior Authorization before calling?
Understanding Prior Authorization helps you describe your question clearly, compare tradeoffs, and avoid focusing on only one number when a licensed review may need more context.
Can Prior Authorization change by plan or policy?
Prior Authorization can vary by carrier, plan type, state, network, timing, and policy language, so use this explanation as education rather than a personal coverage decision.
Questions are easier by phone.
Call 855-367-1095 to talk through your situation with licensed insurance help.
- Licensed insurance help
- No guaranteed eligibility, pricing, or availability
- Educational starting point
Information on this site is educational and does not guarantee eligibility, enrollment, pricing, or availability. It is not a recommendation to buy any specific plan or policy.