This content is for general informational purposes and does not constitute medical, legal, or financial advice. Healthcare rules and costs change annually. Last reviewed: January 1, 2025. Always verify current details with your insurer, employer, or a licensed healthcare navigator.
Prior Authorization
Approval required from your insurer before receiving certain services or medications.
Full Definition
Prior authorization (also called pre-authorization or pre-approval) is a requirement by insurers that you or your doctor get approval before certain procedures, medications, or services are covered. The insurer reviews whether the service is medically necessary according to their criteria. Failure to get prior authorization when required can result in the claim being denied.
Real-World Example
Your doctor prescribes a brand-name biologic drug for arthritis. Before filling it, your pharmacy notifies you that the drug requires prior authorization. Your doctor submits clinical notes; the insurer approves it within 3 days.
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