Prior Authorization
Insurance Glossary
A requirement that a health plan approve a service, procedure or prescription before it is provided, or the plan may refuse to cover it. It commonly applies to imaging, surgeries, hospital stays, durable medical equipment and higher cost drugs, and the provider usually submits the request on the patient's behalf. A denial can be appealed, federal and state rules set the timeframes a plan has to decide, and emergency care is generally exempt from the requirement.
This content is for general informational purposes only and is not insurance, legal, or financial advice. Coverage, exclusions, eligibility, and pricing vary by insurer, by policy, and by state, and only the policy documents control what is covered. Always confirm the details of any coverage with a licensed insurance agent or the issuing carrier before you buy.