Sometimes your insurance needs to approve a treatment or medicine before you get it. This list helps you track the approval process.

Starting the Process

Ask your doctor if the service needs prior authorization.
Ask the doctor's office if they will send the request to your insurance.
Find out how long the approval usually takes.
Write down the name of the person at the clinic who handles this.
Call your insurance to confirm they require approval for this specific code.

Information Your Doctor Needs to Send

Your medical records showing why you need the treatment.
Notes about other treatments you already tried.
The exact billing codes for the procedure or medicine.
A letter explaining why this is medically necessary.
Any recent test results that support the request.

Tracking the Request

Write down the date the doctor's office sent the request.
Call your insurance a few days later to make sure they got it.
Ask the insurance company for the reference number for the request.
Ask the insurance representative when they will make a decision.
Check your mail or online portal for the approval letter.

If You Are Denied

Ask your doctor if they can do a peer-to-peer phone call with the insurance doctor.
Read the denial letter to see why it was rejected.
Find out what extra information they might need.
Start the appeal process if the doctor cannot change their mind.
Ask if a different, covered medicine can work instead.

Tip: Never get the procedure or pick up the medicine until you or your doctor have verified the official approval with your insurance company.

This checklist is educational information only. It is not medical, legal, or financial advice. Confirm details with your insurer, provider, or an official government source.

Prior Authorization Checklist

Starting the Process

Information Your Doctor Needs to Send

Tracking the Request

If You Are Denied