Do doctors have to petition insurers to get some care approved?

Providers, whether they be specialists or primary care doctors, regularly have to seek approval from insurance companies before certain treatments, medications, imaging tests and procedures can be provided or covered.

This process, known as prior authorization, requires insurers to review whether a treatment meets their coverage requirements before agreeing to pay for it. If an insurance company denies the request, physicians and their clinical teams may appeal by submitting medical records, writing letters explaining why the treatment is medically necessary, or speaking directly with the insurer’s medical reviewers.

To help manage this process, some hospital systems, like Yale New Haven Health, rely on specialized support staff, including financial clearance teams and ambulatory care pharmacists, who assist with paperwork, submit authorization requests and track insurance decisions.