Prior Authorization Simplified: Reducing Delays in Patient Treatment
- Jamie P
- Aug 12
- 7 min read
Learn how to simplify the prior authorization process, reduce delays, and improve patient care with practical tips, timelines, and best practices.
Understanding Prior Authorization
Prior authorization is a process in which a healthcare provider must obtain approval from an insurance company before delivering certain treatments, procedures, or medications. This step ensures that the service is covered, medically necessary, and appropriate for the patient’s condition.
While it can feel like a hurdle, the intention is to manage healthcare costs and ensure quality care. Unfortunately, the process can also lead to treatment delays if not handled efficiently.
Common Services That Require It
Specialty medications, especially biologics.
Advanced imaging (MRI, CT scans).
Certain surgeries or hospital admissions.
Behavioral and mental health services.
For patients, prior authorization can mean waiting days — sometimes weeks — before treatment starts. For providers, it means managing paperwork, coordinating with insurers, and tracking responses.
How the Prior Authorization Process Works
Understanding the process helps both providers and patients navigate it more smoothly. While details vary by insurer, most prior authorization processes follow these steps:
1. Service Determination
The provider determines that a service is necessary and checks the insurer’s requirements.
2. Request Submission
The provider submits the prior authorization request with supporting documents — including diagnosis codes, treatment plans, and medical justification.
3. Review by Insurer
The insurance company’s clinical team reviews the request against their guidelines.
4. Decision Notification
Approval, denial, or a request for more information is communicated back to the provider.
Urgent vs. Non-Urgent Requests
Non-Urgent: Usually processed in 5–10 business days.
Urgent: Processed within 24–72 hours when delays could seriously affect the patient’s health.
Prior Authorization Timelines and What to Expect
One of the biggest frustrations for patients and providers is not knowing how long prior authorization will take. While timelines vary by insurer, understanding the typical review periods — and the factors that influence them — can help you better plan care and avoid unnecessary delays.
Standard Timelines
Non-Urgent Requests: Most insurance companies, including Medicare Advantage plans, process these within 5–10 business days.
Urgent Requests: If a delay could significantly affect the patient’s health, urgent requests are usually processed within 24–72 hours.
It’s important to note that “urgent” doesn’t mean “patient is anxious about waiting.” The insurer will assess urgency based on medical necessity and the potential for harm if the service is delayed.
Factors That Affect Turnaround Time
Several variables can speed up or slow down the process:
Completeness of Documentation – Missing clinical notes, test results, or plan of care documents often lead to requests for more information, resetting the clock.
Service Complexity – Advanced imaging, specialty drugs, or experimental treatments may require multiple reviews, extending timelines.
Insurer Backlog – High-volume times (like the start of a new benefit year) can lengthen review periods.
Provider Communication Speed – Delays often occur when insurer requests for additional information aren’t addressed quickly.
How to Shorten the Wait
Submit Early: The earlier the request is filed, the more flexibility you have if there are delays.
Double-Check Requirements: Before submission, confirm you’re using the most current forms and codes.
Monitor Status Daily: Use the insurer’s online portal or a tracking system to catch issues early.
Escalate When Necessary: If the review exceeds the stated timeline, call the insurer directly to request an expedited update.
For Patients
Ask your provider:
Has the request been submitted yet?
When was it submitted?
What’s the expected turnaround time?
Who can I contact for status updates?
Being informed — and politely persistent — can sometimes help move things along.
Common Causes of Delays
Even when the system works as intended, prior authorization can be slowed by preventable issues.
Missing or Incomplete Documentation
If required medical records, test results, or forms are missing, the insurer must request them, resetting the review clock.
Insurance-Specific Requirements
Each insurer — and sometimes even individual plans — can have unique rules.
Communication Gaps
Delays often happen when messages between providers, insurers, and patients aren’t passed along quickly.
Impact of Prior Authorization Delays on Patient Care
Effects on Health Outcomes
Delays in prior authorization can directly impact patient health, especially for those with chronic conditions, cancer, or urgent medical needs. Even a short postponement can cause symptoms to worsen, limit treatment options, or require more aggressive interventions later. In fields like oncology or cardiology, time-sensitive care can be the deciding factor in patient recovery.
Emotional and Psychological Stress
Waiting for an insurer’s decision can be stressful for patients and their families. Uncertainty about whether a treatment will be approved often leads to increased anxiety, frustration, and in some cases, depression — particularly when the patient is already facing a serious health condition.
Treatment Abandonment Risks
Some patients may cancel or forgo treatment entirely if the prior authorization process becomes too complex or lengthy. This can result in poorer long-term outcomes and higher future healthcare costs for both the patient and the system.
Operational Strain for Providers
For healthcare organizations, delays mean repeated follow-ups, rescheduled appointments, and disruptions to carefully planned treatment schedules. This added workload can overwhelm administrative teams and reduce efficiency in other areas of patient care.
Strategies to Reduce Delays for Patients
Patients can take an active role in avoiding bottlenecks.
Prepare in Advance
When you know a treatment is likely to require prior authorization, gather any recent test results, medical records, and a copy of your insurance plan’s coverage list.
Ask the Right Questions
When meeting with your provider, ask:
Does this service require prior authorization?
How long does the process usually take?
Who will follow up on the request?
Follow Up Proactively
Check in with your provider’s office every few days to confirm progress, especially if the treatment is time-sensitive.
Strategies to Reduce Delays for Providers
Providers have the most control over the speed of prior authorization approvals.
Standardize Workflows
Use a clear process from patient intake to submission and follow-up. This reduces confusion and errors.
Use Checklists and Templates
Pre-built forms and document checklists ensure no critical information is left out.
Train Staff and Outsource Support
Training admin staff — or using virtual assistants — keeps the process moving without taking time away from clinical duties.
Explore: Where to Hire a Virtual Assistant
Leveraging Technology for Faster Prior Authorization
Technology can be a major ally in reducing delays.
Provider Portals and E-Submissions
Many insurers offer online submission systems that are faster and easier to track.
Secure Messaging for Coordination
HIPAA-compliant messaging platforms make it easier to share documents and updates instantly.
Tracking Tools
Use project management tools or EHR integrations to monitor pending requests and flag overdue ones.
Explore: Outsource for Business Development
Handling Denials and Appeals
Even well-prepared requests can be denied. The key is knowing how to respond.
Common Reasons for Denial
Service not covered by plan.
Insufficient medical necessity documentation.
Incorrect coding.
Steps to Appeal
Review the denial letter carefully.
Gather additional supporting evidence.
Resubmit with a clear explanation addressing the denial reason.
Maintaining Documentation
Keep copies of all submissions, responses, and appeal documents for future reference.
The Role of Support Services in Prior Authorization
Outsourcing can make prior authorization far more efficient.
How Virtual Assistants Can Help
Gather medical records and documents.
Submit requests via insurer portals.
Track status and follow up proactively.
Benefits for Patients and Providers
Faster approvals.
Fewer errors.
More time for patient care.
Cost-Effectiveness
Hiring a remote assistant often costs less than employing full-time in-house staff for admin work.
Training, Workflow, and Policy Readiness
Streamlining prior authorization isn’t just about submitting forms quickly — it’s about having trained staff, clear workflows, and up-to-date knowledge of insurance policies. Without these, even well-intentioned teams can face repeated denials and delays.
Why Training Matters
Staff who understand insurer requirements are far less likely to make avoidable errors. Training should cover:
Which services require prior authorization for each major insurer.
How to complete forms accurately.
How to identify urgent vs. standard requests.
How to navigate insurer portals for faster submissions.
Tip: Conduct refresher training sessions at least twice a year, or immediately when an insurer updates their policies.
Building an Efficient Workflow
A well-designed workflow ensures nothing slips through the cracks:
Verification at Intake – Confirm insurance details and prior authorization requirements before scheduling services.
Document Preparation – Assign responsibility for gathering clinical notes, lab results, and medical necessity statements.
Submission Protocol – Always submit through the insurer’s preferred channel (often online) for faster turnaround.
Follow-Up Schedule – Designate who will check statuses daily and respond to insurer requests.
Post-Decision Actions – Record authorization numbers and any conditions of approval; start the appeal process immediately if denied.
Mapping this process visually and making it part of your standard operating procedures helps new staff adapt quickly and reduces mistakes.
Policy Readiness
Insurance rules change — sometimes with little warning. Assign a staff member or virtual assistant to monitor policy updates from your top insurers and update your workflow accordingly. This ensures compliance and prevents delays caused by outdated information.
Example: Workflow Redesign in Action
A mid-sized orthopedic clinic faced an average 10-day turnaround for approvals. By:
Implementing prior authorization checks during scheduling,
Training staff to use insurer portals for direct submission, and
Assigning a medical virtual assistant to handle follow-ups,
They cut the average approval time to 5 days. Patients started treatment sooner, and staff reported less stress managing insurer communications.
The Role of Outsourcing in Maintaining Readiness
When in-house staff are overloaded, outsourcing can keep prior authorizations moving without hiring additional full-time employees. Outsourcing in the Philippines or South America can provide cost-effective administrative support trained in healthcare processes.
By combining well-trained staff, efficient workflows, and up-to-date policy awareness, practices can significantly reduce delays — and keep patient care on schedule.
Policy Trends and the Future of Prior Authorization
Recent policy discussions have focused on streamlining prior authorization to reduce its impact on patient care.
Legislative efforts aim to set maximum processing times and require more transparency from insurers.
Technology innovations, like AI-assisted form completion, promise to reduce manual data entry and errors.
The future could see prior authorization become a near-instant process in many cases — but for now, preparation and persistence remain key.
Final Takeaways
Prior authorization is a necessary part of the healthcare system, but it doesn’t have to delay treatment. With clear workflows, proactive follow-up, and the right support, both patients and providers can keep the process moving efficiently.
The most important takeaway? Communication and preparation can make prior authorization a step, not a stumbling block, in delivering timely patient care.
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