You need a procedure. Your doctor says it’s necessary. But your insurance company? They’re not so sure — or they haven’t gotten into motion fast enough.
This is one of the more maddening experiences in healthcare: waiting to get insurance approval. Every day that is lost means more pain, more anxiety and more uncertainty. For some, it means delaying a surgery they urgently require.
The good news is, this process does not have to be a dead end.
There are tangible things you can do, right now, to accelerate the process. You do not need a law degree or a medical background. You just have to understand how the system works — and how to work it back.
This guide breaks down in plain English 6 fast ways to get insurance approval for anyone who is able to follow along and take action today.
Why Getting Insurance Approval Takes So Long in the First Place
Before we dive into the solutions, let’s first understand why approvals take time.
Insurance companies engage in a process known as prior authorization before they agree to cover certain procedures, medications or treatments. This process is designed to contain costs — but it often ends up containing patients instead.
Here’s what usually holds things up:
| Delay Cause | Frequency |
|---|---|
| Missing or incomplete paperwork | Very common |
| Wrong billing or procedure codes | Common |
| Lack of documentation showing medical necessity | Very common |
| Slow communication between a doctor and an insurer | Common |
| Insurer requests more information | Frequent |
| Initial denial requiring appeal | Happens in 1 of 7 cases |
For the majority of patients who undergo prior authorization, it delays care, according to the American Medical Association. Some wait days. Others wait weeks. A few wait months.
But what most people do not realize — many of those delays are preventable. The right moves, made early on, can greatly reduce your wait.
Tip No. 1: Get Your Doctor All in From Day One
Your Doctor Is Your Most Powerful Weapon
This is the step that nearly everyone skips — and it’s the one that counts most.
Insurance companies don’t approve procedures based on what you want. They approve them according to what your physician documents. Even if your doctor is willing to fill out the paperwork, it will stall if that paperwork is vague, incomplete or lacks key details.
Have a straightforward talk with your doctor about how to get your insurance approval from the very first appointment. Ask them specifically:
- “Is this procedure subject to prior authorization?”
- “What paperwork do you have to prepare?”
- “Have you done this with my insurance company before?”
- “Is your office familiar with this insurer’s approval process?”
A doctor’s office that has experience going through prior authorizations with your particular insurer is worth its weight in gold. They know which forms to file, what clinical language to use and where they need to sign.
Medical Necessity Is Everything
The single biggest phrase in insurance approval is medical necessity. Your insurer needs clear documentation that this procedure is not elective — it’s medically necessary.
Your doctor’s notes should include:
- Your diagnosis and how long you have had it
- What treatments you’ve already attempted which have failed
- Why this particular procedure is the next logical step
- Clinical guidelines or medical literature to support the recommendation
The more complete the documentation is, the less reason an insurer has to resist or ask for additional information.
Way #2: Know Your Insurance Policy Inside Out
Read It Before Getting Anything Signed
Most people never read their insurance policy until there’s an issue. By then, it is usually too late for strategic action.
Before you send anything, dig out your policy documents and look for:
- What procedures require prior authorization
- What is “medically necessary” under your plan
- What your appeals process looks like
- Timelines — how many days your insurer has to reply
Most insurance companies are required to respond to standard prior authorization requests within 15 calendar days under federal law. For urgent or expedited requests, they have to respond within 72 hours.
Knowing these deadlines means you can pursue them aggressively if the clock runs out.
| Request Type | Insurer Must Respond Within |
|---|---|
| Standard prior authorization | 15 calendar days |
| Urgent/expedited request | 72 hours |
| Concurrent review (ongoing care) | 24 hours |
| Post-service claim | 30–60 days |
Contact Your Insurer Before You File
Don’t just submit and wait. Start by calling your insurance company’s prior authorization department.
Ask them:
- “What specific documentation do you need for this particular procedure?”
- “Is there any clinical criteria you can share with me?”
- “Is there a particular form my doctor’s office should fill out?”
- “How quickly is the turnaround time at this point?”
Addressing these questions up front helps avoid the biggest source of delays — submitting incomplete or inaccurate paperwork.
If you’re also exploring options like financing your procedure or seeking care abroad, resources like Global Health Financial can help you navigate the financial side of your healthcare journey alongside the insurance approval process.
Way #3: Submit a Complete, Bulletproof Application
One Missing Document Can Hold Everything Up for Weeks
This is where most approvals fail. An incomplete submission doesn’t merely make things slower — it restarts the clock. The insurer puts your case on hold, asks for the missing information and you wait all over again.
Think of your prior authorization submission like a courtroom case. There should be evidence for every claim you make. Every piece of evidence needs to be solid.
Here’s a checklist of what strong submissions usually consist of:
- ✅ Prior authorization form (specific to insurer) completed
- ✅ Medical necessity letter from your doctor
- ✅ Relevant medical records (test results, imaging, lab work)
- ✅ Historical details on past therapies and reasons for their failure
- ✅ Supporting clinical guidelines or peer-reviewed studies
- ✅ Correct CPT (procedure) and ICD-10 (diagnosis) codes
- ✅ Doctor’s contact information for follow-up
The Letter of Medical Necessity: Make It Work for You
The heart of your submission is the letter of medical necessity. A weak letter gets denied. A strong letter gets approved.
A good letter should be:
- Specific — not just “patient needs surgery” but “patient has failed conservative treatment for 18 months and presents with X, Y, Z clinical findings that indicate the procedure is necessary”
- Evidence-based — referencing clinical guidelines such as those from the American College of Surgeons or relevant specialty groups
- Properly formatted — on official letterhead, signed by the treating physician, dated
If your doctor’s office sends a generic letter, kindly request that it be made more specific. You have the right to see what’s submitted in your name.
Way #4: Ask for an Expedited Review When Time Is of the Essence
Get Out of the Regular Queue if You Don’t Have To
This option is unknown to most people. If your medical condition is urgent — meaning that waiting the usual 15 days could cause serious harm to your health — you can formally request an expedited review.
An expedited review moves your case to the front of the line. The insurer is legally required to respond within 72 hours instead of the standard 15 days.
To qualify, your doctor generally must verify in writing that:
- The standard review timeline would put your health at serious risk
- Postponing the procedure might cause your condition to worsen considerably
- The circumstances qualify as urgent under your policy
This is not something to exaggerate or exploit. But if your doctor really thinks waiting is dangerous, don’t hesitate to ask for it.
How to Submit the Expedited Request
The process is straightforward:
- Request that your doctor provide a statement outlining why the situation is urgent
- Call the prior authorization line for your insurer and ask verbally for an expedited review
- Send a written request (email or fax) with your doctor’s statement
- Make a note of the date and time of every call, as well as the name of every representative you talk to
That last point matters more than most people know. Record keeping protects you if the insurer later claims it didn’t receive your request.
Way No. 5: Appeal a Denial — Quickly and Strategically
A “No” Is Not the End of the Road
Here’s a stat that might inspire some hope: according to a Kaiser Family Foundation report, the vast majority of insurance denials that are appealed get overturned. Most people never appeal because they think the decision is final. It is not.
You have rights if your insurance approval request is denied. Federal law guarantees your right to appeal. And if internal appeals fail, you may have the right to an independent external review — someone outside your insurance company reviews your case.
The Two-Level Appeal Process
Level 1 — Internal Appeal
This is your first step. You file a formal appeal with your insurance company. You generally have 180 days from the date of denial to appeal.
Your appeal should include:
- A formal appeal letter detailing why the denial was incorrect
- New or additional medical evidence your doctor can submit
- A response to each specific reason outlined in the denial letter
- Supporting documentation — clinical studies, expert opinions, second medical opinions
Level 2 — External Appeal
If you lose your internal appeal, ask for an independent external review. Your case is reviewed by a third-party organization with no financial stake in the outcome.
External reviews are surprisingly effective. Studies show patients win external appeals far more frequently than anyone expects.
| Stage of Appeal | Average Overturn Rate |
|---|---|
| Internal appeal | 40–60% |
| External review | 40–45% |
Persist after the first “no.” The system is intended to make you quit. Don’t.
Option #6: Hire a Patient Advocate or an Insurance Expert
You Don’t Have to Battle This Alone
Insurance approvals can be a full-time job for some people — and those people are there to help patients like you.
Patient advocates are deep experts on the insurance system. They understand the language, the process, the loopholes and the pressure points. One can significantly accelerate your approval — or rescue a denial that seemed hopeless.
There are different types of advocates available:
| Type | What They Do | Cost |
|---|---|---|
| Independent patient advocate | Manages entire approval process | $100–$300/hour or flat fee |
| Hospital patient advocate | Works within the hospital system | Often free |
| State insurance commissioner | Handles complaints and regulatory issues | Free |
| Non-profit advocacy organizations | Assist with specific conditions | Free |
Little-Known Free Resources
You’re not always required to pay for assistance. Much of it is free:
- Your hospital’s patient advocate — Most hospitals employ one. Ask for them by name.
- Your state’s insurance commissioner — Filing a complaint here may spur a sluggish insurer to act.
- Disease-specific nonprofits — Organizations focused on conditions such as cancer, heart disease or rare disorders frequently employ staff who specialize in insurance navigation.
- Legal aid societies — Some legal aid groups handle insurance cases at no charge if your denial is causing true hardship.
Seeking professional help is not a sign of weakness. It’s a smart move that produces results.
The Approval Timeline: What to Expect (Realistically)
Here’s a bird’s-eye view of how the process typically flows from start to finish, and where you can speed things up at each step:
| Stage | Typical Timeline | How to Speed It Up |
|---|---|---|
| Doctor submits prior auth request | Day 1 | Make sure documentation is complete and detailed |
| Insurer reviews submission | Days 2–10 | Call to confirm receipt and check status |
| Insurer requests more info | Days 5–12 | Respond within 24 hours |
| Decision issued | Days 10–15 | Push for expedited review if urgent |
| Denial issued | Day 15 | File appeal immediately |
| Internal appeal reviewed | Days 15–30 | Submit strong supporting evidence |
| External review (if needed) | Days 30–45 | Use an advocate to help strengthen your case |
Knowing this timeline allows you to understand when to push and when to be patient.
Mistakes That Are Ruining Your Chances of Getting Approved
Avoiding these errors is at least as important as taking the right steps.
Mistake No. 1: Submitting and then waiting in silence. Always follow up. Call every few days. In health insurance, the squeaky wheel gets the grease.
Mistake No. 2: Putting everything in your doctor’s office’s hands without verifying. You are your own best spokesperson. Review everything before it’s submitted.
Mistake #3: Missing appeal deadlines. Most insurers allow 180 days to appeal a denial. Mark that date immediately.
Mistake #4: Surrendering after one rejection. The initial denial is usually a trial run. Many are overturned on appeal.
Mistake #5: Failing to document your communications. Log every call — the date, time, name of the rep and what was said. This protects you when disputes arise.
FAQs: Getting Insurance Approval Faster
Q: What is the typical timeline for receiving insurance approval? Standard prior authorization can take up to 15 calendar days. In urgent cases, a review must be completed within 72 hours. Actual timelines depend on the insurer and the procedure.
Q: What’s a letter of medical necessity and do I actually need one? Yes, you need one. It’s a letter from your doctor that explains in detail why your procedure is medically necessary. Without a strong one, your approval chances drop significantly.
Q: If my insurance company declines my request, can I appeal? Absolutely. Your right to appeal is guaranteed by federal law. You have 180 days from the date of denial to challenge that decision internally — and then to request an independent external review if that fails.
Q: What does “prior authorization” really mean? It means your insurance company needs to approve a procedure before you have it performed — or they may not pay. Many surgeries, specialty medications and certain tests require prior authorization.
Q: Will a second medical opinion help my case? Yes. A second opinion from another physician that supports your need for the procedure lends additional credibility to your submission and will strengthen any appeal.
Q: Should I hire a patient advocate? For difficult cases or repeated denials — yes. The cost of a patient advocate is paid back multiple times over if they help unlock an approval worth thousands of dollars. Free hospital-based advocates are an excellent starting point.
Q: Can my employer assist with insurance coverage challenges? If you have coverage through an employer-sponsored plan, your HR department may be able to escalate the issue. Some large employers also have dedicated benefits navigators who handle exactly this sort of situation.
Before You Submit: Your Quick-Start Checklist
Use this checklist before sending anything off to your insurer:
- [ ] Verified whether your procedure needs prior authorization
- [ ] Contacted your insurer to determine exactly what documentation they require
- [ ] Reviewed your doctor’s letter of medical necessity for thoroughness and detail
- [ ] Included relevant test results, imaging and medical records
- [ ] Ensured correct use of CPT and ICD-10 codes
- [ ] Set a calendar reminder to follow up in 48–72 hours
- [ ] Recorded the names and dates of all calls made
- [ ] Found out what your insurer’s internal appeals process looks like, just in case
The Bottom Line: Take Control of the Process
The biggest mistake you can possibly make is to wait passively for an insurance decision. The system rewards those who are prepared, persistent and informed.
The 6 fast ways to get insurance approval covered in this guide — getting your doctor completely on the same page, knowing your policy, submitting a bulletproof application, asking for an expedited review, appealing strategically and bringing in an expert advocate — each remove a roadblock that stands between you and your care.
You don’t need to be a medical expert or an insurance specialist to make these work. You just need to be organized, proactive and willing to push back when the system pushes you first.
Your health can’t wait forever. Take the first step today.
