What is Preauthorization?

Health plans may require your doctor to get approval before they will pay for certain medical treatments. This process of advance approval is called preauthorization.

Timelines for Preauthorization

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Preauthorization Request

When a health plan gets a request from a doctor to provide a treatment that requires preauthorization, it has three days to review the request and decide whether the suggested treatment or services are medically necessary and appropriate.

Inpatient Facility Requests

If the suggested treatment or services are to be given in a health care facility, your health plan must review the request and make a decision within 24 hours.

Timelines for Appeals

Appealing Denied Requests

If your health plan doesn’t think the suggested treatment or services are necessary and denies the request, then you, your doctor, or someone acting on your behalf can appeal the decision for your health plan to reconsider.

Expedited Appeals

If the denied health care services are for emergency care, continued hospitalization, prescription drugs, or intravenous infusions, you can ask for an expedited appeal of the decision and it has to be resolved within one working day from the date the health plan gets all the information they need.

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Independent Review

If your appeal is denied, you can  ask for a review of the health plan’s decision by an independent review organization. The review organization must make its determination in several days, depending on the seriousness of your condition.

*⃣To learn more about health insurance, visit The Basics, Shopping Guide, and Using Your Insurance sections of our website.