Prior Authorization Delays: How Long Insurance Approval Takes

A denial the day before a flight is the worst version of a common problem. In the American Medical Association's 2024 survey, physicians said their practices handled about 39 prior authorization requests per physician each week, and 93% said prior authorization delayed care. This guide explains how long approval is supposed to take, why it often takes longer, what you can do to speed it up, and when paying without insurance is worth pricing.

What is prior authorization, and does approval guarantee payment?

Prior authorization is your insurer's approval, before you have a test, procedure or drug, that it meets the plan's coverage criteria. It does not guarantee payment. The claim can still be reduced or denied later if your eligibility changes, the provider is out of network, the billing codes differ from what was approved, or your deductible has not been met.

Insurers use it for expensive or frequently overused services, and many attach conditions such as trying physical therapy or a cheaper drug first. Your plan's criteria for each procedure code are usually listed in its member portal or medical policy documents, and your doctor's office can tell you which code it is submitting.

How long does prior authorization take before surgery?

The legal outer limit for most employer plans is 15 days for a non-urgent request and 72 hours for an urgent one, under Department of Labor claims rules. The plan can extend the deadline in some cases, for example when it asks for more information.

For Medicare Advantage, Medicaid and CHIP plans, a CMS rule generally requires decisions within 7 calendar days for standard requests and 72 hours for expedited ones from 2026, and the plan must give a specific reason for any denial. These plans make many decisions: Medicare Advantage insurers fully or partly denied 4.1 million prior authorization requests in 2024, 7.7% of the total, according to KFF.

In practice the clock starts only when the insurer has a complete request. For hip and knee replacements, a 2024 conference study of practices in four US states found that 55% of cases needed prior authorization and the mean time to approval was 30.2 days (2020–23 data, not yet a peer-reviewed paper).

How long is the wait from approval to a surgery date?

There is no national figure. Once approval arrives, the date depends on the surgeon's schedule, the operating room, any pre-operative tests, and how long the approval stays valid. Many approvals cover a set window, so if your date slips, ask whether the approval needs to be renewed. The same goes for changing insurers, which usually means a new request.

Waits to see a specialist in the first place also vary widely by plan, area and specialty, and we found no reliable national number for Medicaid or Medicare patients. If the first available date is months away, ask to be put on a cancellation list and ask whether another in-network surgeon in the same group has earlier openings.

What can you do if prior authorization is delayed or denied?

Call both your doctor's office and your insurer, find out exactly what is missing, and ask for an expedited review if waiting could seriously harm your health. Most stalled requests are waiting for a document, such as therapy notes or imaging reports, that nobody has sent.

If the request is denied, your doctor can ask for a peer-to-peer call with the insurer's reviewer, and you can file an internal appeal and then an external review. Our guide to appealing a health insurance denial covers the deadlines.

How much does a test or procedure cost if you skip insurance?

Often less than people expect for scans and simple procedures, but the payment will not count toward your deductible or out-of-pocket maximum. In the US, a 2025–26 price guide puts an MRI at about USD 300–800 at a freestanding imaging center and USD 1,200–3,500 or more at a hospital outpatient department. Ask for the self-pay price in writing before you book.

Some people also look abroad, where a self-paying patient goes straight from a doctor's order to the test. At a standard department in a Chinese public hospital, foreign patients pay the same listed price as local patients who pay without insurance. Patients in China report paying a median of CNY 484 (≈ USD 72) for a plain MRI of one body part and CNY 210 (≈ USD 31) for a plain CT (Chinese patient reports, 2025–26); international departments charge more. There is no official statistic on how quickly a scan or surgery can be booked, so the hospital should confirm the date in writing before you buy flights.

A scan or operation abroad is usually paid out of pocket. As of October 2026, ask your insurer for written confirmation before assuming any part will be reimbursed, and check the visa route for your stay with the Chinese embassy.