By Sarah Boden
February 17, 2026
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Sarah Boden
Listen in as “Life Kit” host Marielle Segarra and well being reporter Sarah Boden untangle the pink tape that may make the prior authorization course of irritating.
When the physician says you want a prescription or therapy, generally you want approval out of your medical insurance first. That’s referred to as prior authorization. Without that sign-off, insurance coverage received’t pay.
What triggers the necessity for prior authorization is just not totally clear. It’s one other “black box” a part of the well being care system.
You may suppose insurance coverage firms principally goal costly remedies or care approaches when a disagreement over effectiveness prompts a previous authorization overview. Often that’s not the case. Some medical doctors complain they spend plenty of time filling out paperwork to attempt to safe approval for medication or remedies which can be routine.
In the meantime, sufferers may be left in ache, whereas their medical situations worsen.
Health Care Helpline helps you navigate the well being system hurdles between you and excellent care. Send us your tough query and we might faucet a coverage sleuth to puzzle it out. Share your story.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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