Waiting for insurance approval, technically known as prior authorization (PA), is often the most stressful part of medical treatment. Whether you are a patient waiting for a surgery date or a medical practice manager struggling to clear a backlog, the uncertainty is frustrating.
This guide breaks down exactly how long insurance approval takes in late 2025, the new regulations streamlining the process, and actionable steps regarding how to get faster turnaround times.
The Short Answer
If you are looking for a quick estimate, here are the current industry averages for late 2025:
- Prescription Drugs: 1 to 3 business days (often real-time for simple generics).
- Standard Medical Procedures: 3 to 14 business days.
- Urgent/Expedited Requests: 24 to 72 hours (mandated by law in many cases).
- Complex Surgeries: 10 to 15 business days.
While “3 to 5 days” is the standard answer, actual times vary heavily based on the insurer, the complexity of the request, and whether the submission was electronic (fast) or manual (slow).
Detailed Approval Timelines by Procedure
Getting prior authorization for pain medicine or other procedures can take different amounts of time. Just to visualize what goes into getting prior authorization, take a look at this breakdown.
An MRI request is processed differently than a spinal fusion surgery. Use this table to benchmark your wait times.
| Type of Request | Typical Wait Time | Why it varies |
| Prescription Medication | 24–72 Hours | Simple refills are often instant. Specialty drugs (e.g., Ozempic, biologics) trigger deeper reviews for “step therapy” requirements. |
| Advanced Imaging (MRI/CT) | 3–5 Business Days | Often outsourced by insurers to third-party benefit managers (like eviCore or AIM), which adds a layer of review. |
| Elective Surgery | 10–14 Business Days | Requires comprehensive medical notes proving “conservative treatment” (like PT or meds) failed first. |
| Urgent/Inpatient Care | < 72 Hours | If a delay harms the patient’s life or ability to regain function, insurers must expedite. |
| Behavioral Health | 5–10 Business Days | Often flagged for “medical necessity” reviews; high denial rates can extend timelines due to appeals. |
| Workers’ Compensation | 14–30 Days | The slowest category. Involves employers, adjusters, and state-specific legal deadlines. |
Emerging Trend: The Regulatory Landscape For 2025 & 2026
Unlike older articles that guess at trends, here is the reality of the regulatory environment as of late 2025.
The Centers for Medicare & Medicaid Services (CMS) finalized the Interoperability and Prior Authorization Final Rule (CMS-0057-F). While full enforcement hits in 2026, many payers are already transitioning to these tighter deadlines to prepare.
The “7-Day” Rule (Coming Jan 2026)
Starting January 1, 2026, Medicare Advantage, Medicaid, and CHIP plans will be federally required to send decisions within:
- 7 Calendar Days for standard requests (down from the previous 14-day allowed window).
- 72 Hours for expedited/urgent requests.
State-Specific “Gold Card” Laws
Several states (including Texas, Michigan, and West Virginia) have passed “Gold Carding” laws. These rules allow doctors with a history of high approval rates (e.g., 90%+) to bypass prior authorization entirely for certain services. If your doctor is “gold carded,” your approval could be instant.
Why Does It Take So Long? (The “Black Box” Explained)
If you are stuck waiting 10+ days, it is usually due to one of three bottlenecks in the submission-to-decision pipeline. And this leads many patients to ask, why is my prior authorization taking so long?
1. The “Manual” Trap
Despite the availability of Electronic Prior Authorization (ePA), roughly 30-40% of practices still use fax or phone portals.
- ePA Submission: Decisions often return in minutes or hours.
- Fax/Portal Submission: Requires a human at the insurance company to manually data-entry your information. This adds 3–5 days of “queue time” before a nurse even looks at the file.
2. The “Medical Necessity” Review
Insurers use clinical guidelines (like MCG or InterQual criteria) to validate treatment. If a doctor’s notes are vague—for example, listing “back pain” without attaching the physical therapy notes from three months ago—the system triggers a “Peer-to-Peer” review. This forces a phone call between your doctor and the insurance doctor, delaying care by roughly 5 business days.
3. Step Therapy Protocols
For medications, insurers often require you to fail cheaper drugs before approving expensive ones. If the doctor prescribes the expensive one first without documenting why the cheap one won’t work, the request is immediately denied or held for information.
How to Speed Up Insurance Approval
Whether you are a patient or a provider, you can influence the speed of the decision.
For Patients:
- Ask for “STAT” or “Urgent”: If your condition is painful or deteriorating, explicitly ask your doctor to mark the request as “Urgent/Expedited.” This legally forces the insurer to respond within 72 hours.
- Get the Case ID: Do not just wait for a phone call. Ask your doctor’s office for the Case Reference Number and the phone number for the insurance’s “Utilization Management” department. Calling the insurer yourself to check status often flags the file for a quicker look.
- Know the Formulary: Before your doctor prescribes a new medication, check your insurance app’s drug list. If a drug requires PA, ask your doctor if there is a “Tier 1” alternative that doesn’t require approval.
For Medical Practices:
- Adopt Real-Time ePA: Switch to integrated ePA solutions (like Surescripts or CoverMyMeds) inside your EHR. These tools can flag missing information before you submit, preventing the “pending for information” status.
- Submit Clinicals Upfront: Don’t wait for the insurer to ask. Attach the last 3 office notes, imaging reports, and failed conservative treatment history to the initial request.
- Audit Your “Pend” Rate: If your approvals take >7 days, you likely have a data quality issue. Review your denial codes. If “Missing Information” is the top reason, your staff needs training on documentation requirements.
Emerging Trend: Real-Time Adjudication
The industry is moving toward “Real-Time Adjudication.” Similar to how a credit card transaction is approved instantly at a store, insurers are using AI to instantly approve standard medical requests that match clinical history.
By 2026-2027, experts predict that 50% of standard diagnostic approvals (like routine MRIs) will be automated, reducing wait times from days to seconds.
Find Out How to Streamline Your Prior Authorizations
So, how long does insurance approval take? In 2025, you should expect a decision within one week for most standard care, and under 3 days for prescriptions.
If your wait extends beyond 10 days, the process is likely stuck in a manual review loop or missing documentation. Don’t be passive—use the case number to follow up and push the process forward.
Need help navigating a complex approval or denial?
If you are a provider struggling with administrative overlap, we can help audit your PA workflow.