A prior authorization (PA) is an approval process set by some insurance plans. PAs are intended to confirm if your insurance covers a health service, prescriptions, or equipment. Being aware of potential situations where a prior authorization might be needed helps you navigate your care journey confidently.
You may need a prior authorization for:
Behavioral health services (e.g., ADHD evaluations, depression/anxiety care)
Sleep-related services (e.g., sleep studies, CPAP equipment)
Weight loss services (e.g., certain appointments, prescriptions, or programs)
Specialty visits, ongoing treatment, or high-cost procedures
Certain prescriptions or durable medical equipment (DME)
Brand-name drugs when generic options exist
Important note: Even if you’ve previously received coverage, a prior authorization may expire or be required again due to policy rules or plan-year resets.
Unsure if you need a prior authorization? Contact your insurance using the member services number on the back of your insurance.