Prior authorization is one of the most common and misunderstood parts of the healthcare experience. More than 32 million Americans are enrolled in Medicare Advantage plans, and nearly all are in plans that require prior authorization for at least some services.

When a doctor recommends a test, procedure, treatment, or medication, patients often expect that care moves forward right away. But sometimes, health insurers require additional review before approving coverage. That means hospitals and care teams may need to gather and submit medical records, complete paperwork, and explain their medical decision-making with the health insurance company on the patient’s behalf. All of this must occur before care can be delivered, and patients are often left waiting for answers.

Tennessee hospitals are here for every patient—working to improve the care journey. Understanding the facts about prior authorization can help patients make informed decisions, advocate for their care, and better understand how insurance decisions may affect treatment, recovery, and access to services they need.