Listen: Why Do I Need Prior Authorization?

Listen in as “Life Kit” host Marielle Segarra and health reporter Sarah Boden untangle the red tape that can make the prior authorization process frustrating.

When the doctor says you need a prescription or treatment, sometimes you need approval from your health insurance first. That’s called prior authorization. Without that sign-off, insurance won’t pay.

What triggers the need for prior authorization is not fully clear. It’s another “black box” part of the health care system.

You might think insurance companies mostly target expensive treatments or care approaches when a disagreement over effectiveness prompts a prior authorization review. Often that’s not the case. Some doctors complain they spend a lot of time filling out paperwork to try to secure approval for medicine or treatments that are routine.

In the meantime, patients can be left in pain, while their medical conditions worsen.

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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