Waiting on Prior Authorization? Here's What to Do Next.

Before your health insurance will cover certain treatments, tests, procedures, or medications, it may require an additional review known as prior authorization.

Prior authorization can delay the care your doctor recommends. Understanding the process and knowing when to follow up can help you stay informed while your care team works with your health insurance.

For many patients, this can feel like seeking permission from an insurance company after a doctor has already determined what care is medically necessary.

Health insurers say prior authorization helps control healthcare costs. But the process can also create delays, uncertainty, and frustration for patients. More than nine out of ten physicians report that prior authorization delays access to necessary care, while nearly eight out of ten say it can lead patients to abandon a doctor-recommended treatment altogether.^1,2

Behind the scenes, Tennessee’s hospitals, doctors, nurses, and other care team members spend countless hours working with insurance companies on behalf of their patients. They submit medical records, respond to requests for more information, and appeal denials, all to help patients access the coverage and care they need.

Your care team will handle much of this process, but you can play an important role, too. Asking questions, keeping track of key information, and following up can help you understand where your request stands and what should happen next.

While no checklist can eliminate the challenges of prior authorization, the steps below can help you stay informed and engaged as your care team works to move your treatment forward.