The Approval That Got Stuck: Prior Authorization in Springfield, Illinois

“It Should Have Been Approved”

Gary’s cardiologist recommended a procedure. The approval got stuck, denied once, appealed, delayed for weeks, while he waited to find out whether his own plan would cover what his own doctor said he needed.

He wasn’t alone. According to KFF, Medicare Advantage plans made nearly 53 million prior authorization determinations in 2024, compared to roughly 625,000 in traditional Medicare.

Worried a future procedure could get stuck the same way? See how your current plan handles approvals

Why This Happens More on Advantage Plans

Medicare Advantage plans frequently require prior authorization for procedures, imaging, and certain treatments before they’re approved. Original Medicare rarely requires this step at all, which is part of the trade-off between lower premiums and fewer administrative hurdles.

Ask directly how often a plan denies on first request. This data exists and can be requested.

Understand the appeals timeline before you need it, not during a medical wait.

Weigh this against the premium savings honestly, since a delay can cost more than money.

Want an honest comparison before your next renewal? Compare plans with prior authorization in mind

The Bottom Line

Gary’s procedure eventually got approved. The wait wasn’t necessary, and for many Springfield retirees, it’s avoidable with the right plan structure from the start.

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