Prior authorization
Your plan has to OK some care before you get it. See the plan’s deadline and who to call.
Job-based plans must decide within 15 days (they can extend once by 15 days if they tell you why), or within 72 hours if waiting could seriously harm your health.
My prior authorization tracker
- Care
- ______________________________
- Your coverage
- Job-based plan
- Sent on
- ____________
- Reference #
- ____________
- Decision due
- ____________
| Date | Who I spoke with | What they said | Call ref # |
|---|---|---|---|
What to do now
- Call the doctor’s office: confirm the date it was sent and get the reference number. Many delays are a request that was never sent or is missing records.
- Call your job-based plan using the member number on your card. Ask whether they received the request, what’s missing, and the date their decision is due.
- If the deadline passes without an answer: if the plan doesn’t follow its deadlines, you can treat the request as denied and move straight to an appeal or an independent external review.
- If your condition is getting worse, ask the doctor to resubmit it as urgent (expedited).
- Write down every call: the date, the person’s name, and what they said. You may need it for an appeal or complaint.
What to say when you call
- “I’m calling about a prior authorization request for the care. Do you have it?”
- “Is anything missing? Did you ask the doctor for more information?”
- “What date is your decision due? Can I get the decision in writing?”
- “Can I have a reference number for this call?”
Have your insurance card ready. The member services number is on the back.
Did this help you figure out your next step?
Federal deadlines for 2026: CMS’s prior authorization rule (Medicare Advantage, Medicaid and CHIP) and federal claims rules (job-based and Marketplace plans). State laws can set shorter deadlines. Always follow the dates on your plan’s notices.