An insurance company often requires this type of preapproval for certain services, procedures, prescription medications, and medical supplies. Your healthcare team can often help you navigate this ...

Whether you're filling a prescription or scheduling a procedure, chances are you've been asked whether you have prior authorization. By learning to navigate prior authorization and what steps to ...

The Centers for Medicare and Medicaid Services has announced a prior authorization program pilot for original Medicare. The six-year voluntary Wasteful and Inappropriate Service Reduction Model (WISeR ...

In 2026, the Centers for Medicare and Medicaid Services (CMS) will expand prior authorization in the fee-for-service program through the Wasteful and Inappropriate Service Reduction (WISeR) Model.

Prior authorization (PA) is a balancing act designed to manage utilization on the one hand and ensure that patients receive necessary, cost-effective treatments on the other. In today’s health care ...

Why do I need a prior authorization for something that I am already prior-authorized to take? If my doctor says that they want me on a medication, why does my insurance have another say in that?” — ...

Many states are enacting restrictions on insurers’ prior authorization policies, but these laws may increase costs and lead to other undesirable consequences. Many states have adopted or are ...

A group of House Democrats is seeking answers from CMS Administrator Mehmet Oz, MD, regarding a new initiative that will add prior authorization for some traditional fee-for-service Medicare services.

Remember that physician who wanted to develop a Current Procedural Terminology (CPT) code for prior authorizations? It hasn't happened yet, but he hasn't given up on it, either. In May, Alex ...

Large health insurance companies vowed to cut down the use of and improve a common tool to vet requests before letting doctors bill for medical services or prescriptions. UnitedHealthcare, Blue Cross ...

Listen in as “Life Kit” host Marielle Segarra and health reporter Sarah Boden untangle the red tape that can make the prior authorization process frustrating. When the doctor says you need a ...