What you need to know about prior authorizations

July 20, 2026

During Anna’s annual checkup, her doctor ordered a sleep study. She hadn’t been sleeping well for a while, and her husband said she’d been snoring a lot lately. Her doctor thought Anna might have sleep apnea and wanted to check.

Before she could schedule the test, her insurance plan required what’s known as a prior authorization, or pre-approval. This meant Anna’s doctor had to confirm with the insurance company that the sleep study would be covered by Anna’s health plan, so she wouldn’t have any problems when she got there for the test.

If you’ve ever needed prior authorization for a medication or procedure, here’s what you need to know about the process.

Why are prior authorizations used?

Prior authorizations are in place to protect consumers. These pre-approvals help ensure you get the right care following evidence-based, clinical guidelines. Getting pre-approval also means the treatment or medication is covered by your plan.

What services require prior authorization?

Only certain procedures and medications need to be approved beforehand. Things are getting simpler, and fewer procedures or medications require prior authorization. See which services need to be approved in advance and watch a short video that explains the process.

What do I have to do to get prior authorization?

Your doctor usually handles getting approvals for you. Most often, you don’t have to do anything other than be sure the approval is in place before getting the service. When prior authorization is needed, we’ll work with your doctor to review it as quickly as possible. These decisions are made by doctors, nurses, and other clinically qualified experts, along with the responsible use of AI.

What if my prior authorization is denied?

If prior authorization is not approved right away, this is usually because more information is needed. Our team may need more details, or information could be missing in the request. We’ll ask your doctor for more information and will review it right away.

Can I appeal a prior authorization?

Any time your prior authorization is not approved, you have the right to appeal.

Are you a Florida Blue member?

You can track the status of your prior authorizations for health care and prescriptions 24/7 in your online member account.

We know the prior authorization process can be frustrating. We work to make this process as simple as possible for you and your doctor, to ensure your care is covered.