Reviewed by Main AI · Updated July 2026
Prior authorization is your insurer requiring approval before covering certain care. Denials usually cite medical necessity or a preferred alternative — and they’re frequently reversed on appeal with the right documentation.
Prior authorization (pre-approval) is the insurer’s gate in front of certain medications, imaging, procedures, and specialists. Denials typically claim the care isn’t medically necessary, that a cheaper alternative should be tried first ("step therapy"), or that paperwork was incomplete. None of those is the final word. Your doctor can submit additional clinical justification, request a peer-to-peer review with the insurer’s physician, or document why the preferred alternative is inappropriate for you. Prior-auth denials are among the most commonly overturned — persistence and documentation win.
A requirement to try a cheaper treatment first before the insurer covers the prescribed one. Your doctor can seek an exception if the alternative is inappropriate for your case.
Yes — a peer-to-peer review lets your physician discuss the case directly with the insurer’s medical reviewer, and it frequently resolves denials.
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