Understanding the Prior Authorization Process
Important to Know
Prior authorization is a decision made by your insurance company—not by your surgeon or our office.
Before certain imaging studies, procedures, or surgeries can be scheduled, your insurance plan may require approval to confirm that the service meets its medical necessity guidelines.
Our dedicated authorization team works directly with your insurance company to submit the required medical records, respond to requests for additional information, and advocate for timely approval.
While we cannot control the insurance company’s review process or timeline, we are committed to keeping you informed and supporting you every step of the way.
What Is Prior Authorization?
Many health insurance plans require prior authorization, also called pre-authorization or pre-certification, before they will approve certain medical services, including:
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Advanced imaging studies, such as MRI or CT scans
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Surgical procedures
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Other specialized medical services
Prior authorization is a review conducted by your insurance company to determine whether the requested treatment meets its medical coverage guidelines.
It is not a decision made by Premier Neurosurgery.
While we understand that waiting for approval can be frustrating, our team is committed to working diligently on your behalf to obtain authorization as quickly as possible.
Why Does My Insurance Require Prior Authorization?
Insurance companies use prior authorization to determine whether a service is considered medically necessary before they agree to cover it.
Depending on your insurance plan, they may require:
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Recent office visit documentation
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Physical therapy records
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Imaging reports or X-rays
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Medication history
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Documentation of conservative treatments
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Additional medical records from other providers
Each insurance company has its own requirements, and those requirements can vary from patient to patient.
What Happens After My Provider Recommends Imaging or Surgery?
Once your provider determines that additional imaging or surgery is appropriate, our authorization specialists begin working with your insurance company.
The process typically includes:
Step 1: We gather your medical records and supporting documentation.
Step 2: We submit a prior authorization request to your insurance company.
Step 3: The insurance company reviews the request.
Step 4: We respond to any requests for additional information, if needed.
Step 5: We notify you once a decision has been made.
If your authorization is approved, we will assist with scheduling your imaging study or surgery.
How Long Does Prior Authorization Take?
Approval times vary depending on your insurance company.
Typical timeframes include:
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Imaging studies: 2–10 business days
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Surgical procedures: 5–15 business days
Some requests are approved quickly, while others require additional review or a physician-to-physician discussion with the insurance company.
These timeframes are estimates and are determined by your insurance carrier—not by Premier Neurosurgery.
If Additional Information Is Needed
Sometimes your insurance company may request:
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Additional medical records
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Updated office notes
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Recent imaging
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Documentation of previous treatments
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A peer-to-peer review between your surgeon and the insurance company’s medical reviewer
If this occurs, our team will work to provide the requested information as promptly as possible.
What If My Insurance Denies the Request?
A denial does not always mean the requested treatment is inappropriate.
If your insurance company denies authorization, we will carefully review the reason and determine the next appropriate step.
This may include:
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Submitting additional medical documentation
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Requesting reconsideration
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Filing an appeal
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Completing a physician-to-physician review when appropriate
Some insurance plans have multiple levels of appeal before a final decision is made.
How You Can Help Prevent Delays
You can help keep the process moving by:
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Providing complete and accurate insurance information
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Informing us of any insurance changes immediately
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Completing any recommended physical therapy or conservative treatment when appropriate
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Obtaining records from outside providers if requested
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Responding promptly if our office contacts you for additional information
Frequently Asked Questions
Can I schedule my MRI or surgery before authorization is approved?
In most cases, no. Your insurance company must approve the service before it can be scheduled for coverage under your health plan.
Can I call my insurance company?
Yes. Many patients find it helpful to contact their insurance company and ask about the status of their authorization.
Having your member ID number available may help expedite the conversation.
Will calling my insurance company speed up the process?
Sometimes.
While it does not guarantee faster approval, patients may learn whether additional information is needed or whether the request is still awaiting review.
Why does my insurance require physical therapy before approving surgery or an MRI?
Many insurance companies require documentation showing that conservative treatment has been attempted before they approve advanced imaging or surgery.
These requirements are established by your insurance plan and may differ from your surgeon’s medical recommendations.
Our Commitment to You
We understand that waiting for authorization can be stressful—especially when you are in pain.
Our experienced authorization team works closely with insurance companies every day to advocate for our patients and obtain approvals as efficiently as possible.
We appreciate your patience throughout this process and will keep you informed every step of the way.
If you have questions regarding your authorization, please contact Premier Neurosurgery. We’re here to help.