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Why is it so hard to get a prior authorization?

A prior authorization form will include information about you, your medical conditions, and your health care needs. Its important to fill out the form completely and accurately. Incomplete or incorrect information could delay your request or result in a denial.

Why are prior authorizations so difficult?

Shifting rules and overall payer complexity make it difficult for health systems to stay ahead of what they need to get prior authorization requests approved, which lengthens the time an auth takes and results in more denials.

How do I get a prior authorization for health insurance?

What are the steps to obtaining prior authorization? Your insurance company will review your doctors request. Once theyve decided, theyll send their decision to both you and your medical provider in writing. If your doctor feels that you cant wait that long, they can submit an urgent or expediated request.

Why do prior authorizations get denied?

The most common reason in my experience why PA requests get denied, is quite simply a lack of information. For example, its very common for PA requests for MRIs or CTs to require that an X-ray and/or ultrasound be done first, to see if that will provide enough information for the doctor to treat the issue.

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