Prior authorization (prior auth)

What prior authorization is

Prior authorization (sometimes called prior auth or pre-authorization) is when an insurance plan requires the clinician to get pre-approval before a service or medication is covered. The clinician submits a brief justification — what's being requested, why, and how it fits clinical guidelines — and the plan approves or denies it.

What it looks like in practice

Most outpatient therapy and psychiatry visits do not require prior authorization. The most common cases where prior auth is needed:

• Some Medicaid (NJ FamilyCare) MCOs require prior auth for psychiatric medication beyond a certain quantity, for some controlled substances, or for TMS
• Some commercial plans require prior auth for TMS or for therapy beyond a session-count threshold (e.g., after 20 sessions)
• Most plans require prior auth for inpatient or partial-hospitalization care

When prior auth is needed, we handle it. You don't need to call your plan or fill out forms — our intake or psychiatry team submits the request and follows up. Most prior-auth requests are approved within one to three business days.

When this matters for you

You usually won't need to think about prior auth. We catch it during the insurance verification step and submit the request before your appointment if needed. If a request is denied, we'll explain why and tell you what alternatives exist. Patients are not billed for visits where prior auth was required and we failed to obtain it — that's our responsibility, not yours.