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How prior authorization protects you

We take steps to ensure your treatment is safe, effective and medically appropriate. Learn about our prior authorization process.

What is prior authorization?

What is prior authorization?

Some procedures, tests and prescriptions need prior approval to be sure they’re right for you. In these cases, your doctor can submit a request on your behalf to get that approval. This is called prior authorization. You might also hear it called “preapproval” or “precertification”.


This extra check connects you to the right treatment, so you can achieve better health sooner. That might mean a full recovery or being able to manage a condition with success.

Helping you through every step


First, your doctor will get the process started

First, your doctor will get the process started

When you see your doctor, they’ll help you get the prior authorization you need. We make it easy, so you can receive a timely decision. And we’ll stay in touch throughout the review process.


If my doctor recommended this treatment, why does it need review?

Not everything requires this extra check. However, some treatments may require a second review to ensure they’re medically necessary, effective and safe for you. This helps you get the highest quality care.

Next, we’ll work with your doctor on your request

Next, we’ll work with your doctor on your request

We review each request against the highest quality clinical guidelines and scientific evidence. This includes:


  • Guidelines from nationally recognized health care organizations
  • Peer-reviewed, published medical journals
  • Available studies on a particular topic
  • Evidence-based consensus statements
  • Expert opinions of health care professionals

We’ll also communicate with your provider throughout the process. We’ll come to a decision within 14 days and notify you and your doctor.


It’s easy to track the status of your request

You can log in to your member website to get a quick update. Don’t have an account? It only takes a minute to register as a new user. And the benefits are well worth it.

Your request is finalized: What’s next?


If your request was approved

Our clinical experts agree with your provider’s treatment recommendation. And you don’t need to take any further action. Have questions? You can call your provider or the number on your Aetna® ID card.

If your request was not approved

You’ll receive a letter from us explaining why the request was denied. In some cases, it may be not enough clinical documentation. Other times, guidelines for medical need might not be met. If you disagree with the decision, know that you have options. You can:


  • Request a peer-to-peer review. This is a review between your care provider and an Aetna medical director. They’ll discuss the guidelines for medical need that are relevant to your request. Your provider can also share more medical information.
  • Request a formal appeal. The letter you receive from us includes steps to request a formal appeal. You can also find claims appeal resources here.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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