Prior Authorization Denied? Your In-Network Doctor Fixes This, Not You

If you just got a prior authorization denial notice, here's the short version: if you're seeing an in-network doctor, this is their problem to solve, not yours.

That's not just good advice — it's written into their contract with your insurance company. But it also means you shouldn't assume it's being handled. A quick call to your doctor's office goes a long way.

What Prior Authorization Actually Is

A prior authorization is something that your doctor submits to your insurance company to get approval for the care that they want to provide you. Obviously your doctor knows what's best for you, and the prior authorization is not about whether or not you'll get the care — it's about whether or not your insurance company is going to pay for the care.

It's important to understand what prior auth is really about. It's not about whether you'll get the care. It's about whether your insurance company will pay for it. Most prior authorizations get approved on the first try — but the ones that don't are where things get frustrating.

Why It's Your In-Network’s Doctor's Job

When you see an in-network doctor, their contract with your insurance company includes managing prior authorizations— and handling any denials that come back.

If you're going to an in-network doctor, it is 100% your doctor's responsibility to get this taken care of. That's part of their in-network contract.

This applies across basically every major insurer: Anthem, UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield. They all require in-network providers to handle prior auth as a condition of being in-network. In most cases, in-network providers also can't bill you for services that got denied because of a prior auth failure on their end.

So when you get a prior authorization denial notice, your job is to make sure your doctor's office knows about it and is handling it — not to work it out with your insurance company yourself.

What You Should Actually Do

Call your doctor's office and confirm two things:

• They received the denial

• They're working on the appeal or resubmission

That's it. You don't need to call your insurance company. You don't need to file anything yourself. The back-and-forth happens between your provider's office and your insurer.

If your doctor's office hasn't received the denial yet, share what you got so they can start working on it right away.

When Prior Authorizations Keep Getting Denied

Sometimes the first appeal doesn't work, and your doctor has to try again — or come back to you with options.

If it continues to get denied, your doctor is probably going to reach out to you and talk to you about what your other options are for care, and whether or not you want to go forward with it even if it's going to get denied by your insurance. That's a conversation you need to have with your doctor.

That conversation might cover:

• Alternative treatments that your insurance is more likely to approve

• Whether you want to proceed with the original treatment and pay out of pocket

• The cost if you decide to move forward without coverage

That's a decision between you and your doctor. Your insurance company isn't part of that conversation.

The Timeline to Expect

Prior auth denials don't need immediate panic. Most appeals take at least a few weeks, and more complex cases can take longer.

Insurers have to respond to urgent care appeals quickly (within 72 hours for most plans), but routine pre-service and post-service appeals can take 30–60 days. The upside is that your doctor is handling it during that time — your job is to follow up periodically to make sure it hasn't gotten lost.

Some specialties see higher prior auth denial rates than others. According to this KFF Tracking poll in 2022, Advanced imaging (MRI, CT), specialty medications, durable medical equipment, and inpatient psychiatric care tend to get denied more often. Routine primary care and preventive care usually don't require prior auth at all.

When You Need More Support

If your prior auth keeps getting denied, your doctor's office isn't moving on it, or you're facing a complicated appeal, Granted can step in. We review the denial, build the appeal, and handle the communication with your insurer. You only pay if we win.

Frequently Asked Questions

Do I need to call my insurance company if I get a prior authorization denial? Usually, no. If you’re seeing an in-network provider, the back-and-forth is typically between your doctor’s office and your insurer. Your job is to notify your doctor’s office and confirm they’re appealing or resubmitting.

Can my doctor bill me if the prior authorization was denied? Often they can’t if you went in-network and the denial was due to a prior auth issue on the provider’s side. Billing rules vary by plan and situation, so if you get a bill, call the provider’s billing office and ask them to review it as a prior-auth/coverage issue.

How long does a prior authorization appeal take? It depends on whether it’s urgent. Urgent appeals are often required to be decided quickly (commonly within 72 hours), while routine appeals can take weeks and sometimes 30–60 days.

What if my doctor’s office says they “can’t” do anything? Ask who handles prior authorizations/appeals and request that your case be routed to that person or team. You can also ask for the denial reason/code and what documentation the insurer is requesting so the office can resubmit appropriately.

What if I’m out-of-network? The “provider handles it” dynamic is much less reliable out-of-network. You may need to coordinate more directly, and you could be responsible for more paperwork and costs depending on your plan.

What if I already paid out of pocket or skipped care because of the denial? Ask your doctor’s office whether the denial can be appealed retroactively and whether resubmission is possible. If you move forward with care, discuss a contingency plan: what happens if it’s denied again, and what your out-of-pocket exposure would be.

TL;DR

• Prior authorization is your doctor's request for insurance approval before care

• For in-network providers, handling a prior auth denial is their contractual responsibility

• Call your doctor's office to confirm they received the denial and are handling it — don't assume

• You don't need to call your insurance company yourself

• If appeals keep failing, your doctor will talk through alternatives or out-of-pocket options with you