Bills and insurance
What Is Prior Authorization in Health Insurance?
Prior Authorization · say it: PRY-er aw-thor-ih-ZAY-shunAlso written: prior auth, PA, preauthorization, pre-approval, precertification
Short answer
Prior authorization is approval your insurer must give before certain treatments, tests or medicines are covered.
What it means
Some insurance plans require your doctor to get permission before they will pay for specific services, such as some scans, procedures, hospital stays or expensive medicines. That permission is prior authorization.
Your doctor's office usually sends the request with medical information explaining why the service is needed. The insurer may approve it, ask for more information, suggest an alternative, or deny it.
If a required prior authorization is not obtained, the insurer may not pay. If a request is denied, there is usually an appeals process, and your doctor's office can often help.
Where you may see it
- Insurance letters and portal messages
- Pharmacy notices
- Explanation of benefits (EOB) statements and claim denials
📄 How it looks on a report
Claim denied: prior authorization required and not obtained.
🙅 What it does not mean
- Needing prior authorization does not mean the treatment is not medically appropriate.
- A denial is not always final; there is usually an appeal process.
- Approval is not a promise of full payment; deductibles and coinsurance can still apply.
🗒️ Questions to ask your doctor
🧾 Reports where you will see “Prior Authorization”
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🔗 Read more from trusted sources
- “Prior Authorization” on MedlinePlus ↗
US National Library of Medicine
- HealthCare.gov glossary ↗
US government health insurance glossary
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General information about a medical word, not advice about your own results. Ask the clinician who ordered the test what it means for you.