Pre-authorization (prior authorization)

Some types of health services, treatments, drugs, and medical equipment require a pre-authorization (also called prior authorization, prior approval, or precertification) before your doctor can continue with your care plan. Pre-authorizations are generally needed for highly-regulated or complex services, care, and medications.

Your doctor is responsible for filing a pre-authorization with your insurance company before they take action. Once the insurance company approves the authorization, they can schedule an appointment, fill a prescription, or order your equipment.

Pre-authorizations can sometimes take a day or two to file, so it’s important to get them done well ahead of time. When your doctor is laying out a care plan for you, make sure to ask them if any items need authorizations, or call your health insurance company to confirm.

The only time pre-authorizations are waived is in an emergency (opens in new tab) situation. Then, these services, drugs, and equipment will be covered per your insurance benefits.

One caveat: Just because your doctor files a pre-authorization request doesn’t guarantee your health insurance plan will cover the cost. These services, drugs, and equipment must be medically necessary (opens in new tab) for your benefits to kick in. Again, it helps to ask questions up front, before you get care, to avoid unexpected bills later.