Most prior authorization decisions take between 72 hours and 14 calendar days, depending on whether your request is classified as urgent or routine and what type of insurance you have. Prescription drug authorizations tend to be faster, while approvals for procedures and specialist services can stretch longer, especially if your provider needs to submit additional documentation.
Timelines by Insurance Type
The wait time for a prior authorization decision depends heavily on who your insurer is and what rules govern them. Here’s how the major categories break down.
Medicare Advantage (Parts C and D): For prescription drugs under Part D, plans must respond within 72 hours for standard requests and 24 hours for expedited ones. For medical services, a new federal rule taking effect in 2026 will require decisions within 7 days for routine requests and 72 hours for urgent ones.
Medicaid managed care: Federal rules currently give Medicaid plans up to 14 calendar days for standard prior authorization decisions and 72 hours for expedited requests. Starting in January 2026, the standard window shrinks to 7 calendar days. States can set shorter deadlines than the federal minimum, and some do.
Commercial insurance (employer plans, marketplace plans): There is no single federal law setting a universal deadline for private insurers. In practice, most large commercial plans aim for about 7 days on non-urgent requests. Blue Cross Blue Shield of Michigan, for example, states that non-urgent reviews can take up to seven days and notes this is the most common type of request. Urgent requests at most commercial plans are typically processed within 72 hours or less. Your actual timeline depends on your specific plan and the state you live in.
Urgent vs. Standard Requests
Every insurer distinguishes between urgent (sometimes called “expedited”) and standard prior authorization requests, and the difference in wait time is significant. A standard request for an elective MRI or a non-emergency surgery might sit in the queue for a week or two. An urgent request for a medication you need immediately or a procedure that can’t safely wait is supposed to be turned around in 24 to 72 hours.
Your doctor’s office is the one who flags a request as urgent. The insurer evaluates whether the clinical situation qualifies. Generally, a request is considered urgent when waiting for the standard timeline could seriously jeopardize your health, your ability to function, or could cause severe pain. If an insurer downgrades an urgent request to standard, that decision itself can be appealed.
Why Authorizations Get Delayed
The timelines above represent how long the insurer has to make a decision once they have everything they need. The clock doesn’t always start when your doctor submits the initial request. If the insurer determines the submission is incomplete, they’ll “pend” the request and ask for more information, which effectively pauses the timeline.
The most common reasons for delays include missing medical records, incomplete documentation of your symptoms or diagnosis, lack of test results that support the requested treatment, and no evidence that you’ve tried less expensive alternatives first. Insurance reviewers want to see your medical history, what symptoms you’re experiencing, what diagnostic results confirm your condition, and what other treatments have already been attempted. Gathering and submitting all of this takes time on your provider’s end.
In some cases, before issuing a denial, the insurance company’s medical reviewer will request a “peer-to-peer” conversation, which is a phone call between their physician and your physician to discuss why the treatment is necessary. This adds another layer of delay, though it can sometimes prevent a denial altogether. If your authorization has been pending for longer than expected, calling your doctor’s office to ask whether the insurer has requested additional documentation is a good first step. Often the holdup is on the provider side, not the insurer side.
What Happens if You’re Denied
A denied prior authorization is not the end of the road. For employer-sponsored plans governed by federal law, your insurer must respond to a first-level appeal within 15 days for pre-service claims. If the first appeal is denied, you can file a second-level appeal, which also has a 15-day response deadline. These are legal maximums, so insurers sometimes respond faster.
Medicare and Medicaid plans have their own appeals processes with similar or shorter deadlines. During an appeal, your doctor can submit additional clinical evidence, provide letters of medical necessity, or request that a different reviewer examine the case. Many denials are overturned on appeal, particularly when the original submission was missing key documentation.
State Laws That Speed Things Up
Some states have passed laws that go well beyond federal minimums. Vermont, for instance, shortened its prior authorization timelines to 24 hours for urgent requests and two business days for non-urgent ones. At least 10 states, including Arkansas and West Virginia, have enacted “gold card” laws that exempt doctors with strong approval track records from the prior authorization process entirely. If your doctor consistently gets approved for a particular service, they may be able to skip the process altogether in those states.
These laws only apply to state-regulated insurance plans, which typically includes individual marketplace plans and fully insured employer plans. Large self-funded employer plans are regulated at the federal level and aren’t bound by state-specific rules. If you’re unsure which category your plan falls into, your HR department or your insurance card’s customer service number can clarify.
How to Track Your Request
Most insurers now offer online portals or mobile apps where you can check the status of a pending prior authorization. Look for a “claims” or “authorizations” section after logging in. If you don’t see your request listed, it may not have been submitted yet by your provider’s office.
When you’re waiting on a prior authorization, keep a few things in mind. Write down the date your doctor’s office submitted the request so you know when the clock started. If you’re past the expected window, call your insurer’s member services line and ask for the status. Reference the authorization or case number if you have one. If the request has been pended for missing information, contact your doctor’s office directly and ask them to prioritize the submission. The single most effective thing you can do to shorten the process is to make sure your provider’s office submits complete documentation the first time around.