Guide 9: Introduction to Prior Authorization Process
Sometimes, your doctor needs permission from your health insurance before they can provide certain treatments, medications, or procedures. This is called prior authorization (or pre-approval).
Here’s what it means for you—and how BillCare helps make the process faster and easier.
❓ What Is Prior Authorization?
It’s when your insurance company reviews a service before you get it to decide if they’ll cover the cost.
This is common for:
Expensive tests (like MRIs or CT scans)
Some medications
Specialist care or surgeries
Ongoing therapies (like physical therapy)
💡 Why it matters:
Without approval, your insurance might not pay—and you could be stuck with a big bill.
👨⚕️ What Does Your Doctor Do?
Your doctor or clinic will:
Send paperwork to your insurance company
Explain why the care is needed
Wait for approval (this can take a few days or even longer)
💡 How BillCare helps:
We automatically spot when prior authorization is required—and send the request right away to speed things up.
3. 📬 What Happens Next?
Your insurance company will respond in one of three ways:
✅ Approved – You’re good to go!
❌ Denied – They won’t cover it (but you can appeal)
⏳ More Info Needed – They ask your doctor for extra details
💡 How BillCare helps:
We track every request and send updates to your care team—so no one drops the ball or misses a deadline.
4. 🔁 What If You’re Denied?
If your request is denied, you have the right to appeal.
Your clinic can:
Send more information
Explain why the care is medically necessary
Ask for a review or second opinion
💡 How BillCare helps:
We guide your provider through the appeal steps and keep things moving, so you’re not left waiting.
✅ BillCare = Less Waiting, Less Worry
With BillCare working behind the scenes:
🕒 You get faster approvals
📉 Fewer denials and delays
🧾 Less chance of surprise bills
We help your doctor handle the paperwork, so you can focus on feeling better—not fighting with your insurance.