What Is Prior Authorization (AKA Pre-Approval)?

Prior authorization, sometimes called pre-approval, is a process where insurance companies must approve certain medical services, treatments, or prescriptions before they are covered. While intended to control costs and prevent unnecessary treatments, it often creates administrative hurdles that delay care.

Why does prior authorization matter?

• Delays in treatment: Patients may wait days or weeks for insurer approval, which can be critical for those needing urgent care or ongoing treatment for chronic conditions.
• Complicated for seniors: Medicare beneficiaries, particularly those with Medicare Advantage plans, often face prior authorization requirements for services like specialist visits, imaging, and prescriptions.
• Risk of denials: Even medically necessary treatments can be denied, requiring appeals that put the burden on patients and providers.

How Solace can help

Solace advocates can help patients and caregivers determine whether prior authorization is needed, handle the phone calls and paperwork to secure approvals, and follow up with insurers to reduce delays. If a request is denied, an advocate can guide you through the appeals process to fight for coverage.

Further Reading

How To Get Prior Authorization for Medication

What To Do When Your Prior Authorization Is Denied

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