When should you follow up with the insurance company if the patient has not received a decision?

Following up with the insurance company after submitting a prior authorization request generally hinges on industry norms and guidelines. A 30-day window is commonly recognized as a reasonable timeframe within which to expect a decision from the insurer. By this point, the insurance company has typically had sufficient time to review the request, process it, and arrive at a determination.

Waiting 30 days allows for the possibility of delays that can naturally occur in healthcare processes, yet it ensures that timely follow-up occurs, which is beneficial for both the patient and the healthcare provider. Following up too early, such as within 14 days, might not yield much information, as the insurance company may still be actively processing the request. On the other hand, waiting 60 days or longer could potentially lead to unnecessary delays in patient care and might breach the expectations set forth by various regulatory bodies about timely communication and decision-making around prior authorizations.

Thus, adhering to a 30-day follow-up guideline strikes a balance between patience and urgency in managing prior authorization requests effectively.