Preauthorization and You: A Health Advocate’s Guide to Navigating Insurance Approvals
Preauthorization isn’t just paperwork—it’s a pivotal step that can make or break your access to timely care. As an aspiring health advocate, your role is more than just asking questions at appointments; it’s understanding the insurance checkpoints that can delay or deny essential treatment. In this article, we’ll walk through what preauthorization involves, how you can take proactive steps to support the process, and why being prepared can protect your health, your finances, and your peace of mind.
What Preauthorization Really Means
Preauthorization is the process of getting advance approval from your health insurance plan before receiving certain services, treatments, or prescriptions. It’s often required for specialized care like MRIs, surgeries, or brand-name medications.
But here’s the catch: preauthorization is not a guarantee of coverage. Even if a request is approved, the insurer can still deny payment later if other conditions aren’t met. That’s why knowing how this process works—and how to follow up—is critical.
Your Role as a Self-Health Advocate
As a health advocate, your job isn’t to do the provider’s work—it’s to own your part of the process. Here’s how:
Before the Appointment
- Know what to ask your insurer: When a treatment, test, or prescription is recommended, it’s your responsibility—not your provider’s—to find out whether it requires preauthorization. This is not something your doctor’s office is obligated to handle on your behalf.
- Call your insurance plan directly: Ask, “Does this service require preauthorization under my plan?” and “What documentation is needed for approval?” Note any codes or requirements they mention. This step ensures you understand your benefits before any services are scheduled.
- Document what you learn: Write down the date of your call, who you spoke with, and any reference numbers they provide. This information will help you if you need to follow up or appeal later.
During the Process
- Track communication: Write down the date, time, and name of every insurance or provider contact. Request reference numbers.
- Follow up: Contact the provider’s office to make sure the prior authorization request has been submitted.
If It’s Denied
- Understand your appeal rights: You can request a review of the decision.
- Ask for a letter of medical necessity: This can strengthen your case.
- Re-submit with new documentation if needed: Persistence can often lead to a reversal.
Tools to Support You
Preauthorization is just one step in a much larger system of claims, costs, and communication. That’s why the Patient Better Academy doesn’t just explain how to get a service approved—it trains advocates to manage the entire financial and administrative side of care with skill and clarity.
Inside Course 3: Understanding Medical Claims, Lessons 1 through 4 offer a deep, structured exploration of:
- How the claims process works, from provider billing to insurer decision-making
- What to do when you’re approved—and why approvals can still be reversed later
- Appeals and denials—including how to respond, communicate, and escalate effectively
- Financial management as a health advocate, including setting expectations with providers and tracking your own responsibilities
This isn’t a surface-level checklist. It’s a step-by-step, real-world education that builds confidence and clarity—so you’re not just reacting to the system, you’re working within it intelligently.
Empowered, Not Intimidated
Preauthorization may seem like just another form, but it holds real power over your care. When you know how it works and how to engage, you stop being a passive recipient of health decisions and start becoming an active partner.
At Patient Better, we believe that confidence in care starts with clarity. And when people are trained, they’re ready. When they’re ready, they’re more likely to succeed.
Do you have any questions about your results or how to improve your healthcare proficiency?
Disclaimer: This education was brought to you today by The Patient Better Project Inc., a 501(c)(3) organization dedicated to reshaping the way patients and caregivers navigate care. We are committed to empowering individuals with the knowledge and tools necessary to take control of their health journeys, ensuring that everyone can access the care they need with confidence and clarity.
The information provided here is for educational and entertainment purposes only. It is not intended as, nor should it be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call 911 or your local emergency number.
