Glossary → Medical & Insurance
Medical & Insurance

Prior Authorization

Insurer approval required before certain care is covered.

Prior authorization (or pre-authorization) means your insurer must approve a service, drug, or procedure in advance or it may not be covered. Missing it is a common reason claims are denied — and a common thing to appeal.

In practice

“This procedure requires prior authorization from your plan.”

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When a denial is really a paperwork problem

Many “not covered” denials are actually missing or expired authorizations, not a judgment that the care was unnecessary. If a claim was denied for lack of prior auth, your provider can often submit a retroactive request or you can appeal — the care itself may be perfectly coverable.

See this in your own document: run a free analysis — findings quote the exact language.

What it looks like in a real document

“Claim denied: no prior authorization on file.”

This denial reason is frequently fixable. Ask the provider to submit the authorization or a peer-to-peer review, and appeal within your plan’s deadline.