What is prior authorization?
Prior authorization (PA)—also called preauthorization—means the health plan must approve certain care before it will cover it. Doctors or hospitals often submit PA for you, but you still have rights if PA is denied.
A PA denial is different from a bill denial after care already happened. With PA, the fight is usually about whether the plan will allow the treatment at all.
Overview for any state: Prior authorizations. This page is Louisiana-only.
Confirm plan type: Louisiana: Start Here.
Louisiana PA rules
Louisiana's utilization review reforms are in RS 22:1260.41–1260.48, especially RS 22:1260.44 (effective for many plans on or after January 1, 2025 under Act 468 / HB 468).
Non-urgent prior authorization
- Decision communicated to the provider within 5 business days of receiving the request
- If the issuer requests more information, within 5 business days of receiving that information
Urgent prior authorization
- Issuer must offer expedited electronic review when the provider certifies urgent medical necessity
- Decision within 2 business days of receipt, or within 48 hours after any required additional information
If the plan misses PA deadlines
If the issuer fails to decide within these timeframes, it cannot deny a claim based solely on lack of prior authorization (RS 22:1260.44(G)).
Other review types
- Concurrent review: often within 24 hours after necessary information
- Retrospective review: often within 30 business days; written notice to enrollee and provider within 3 business days of the decision
Prescription drug PA forms
Louisiana requires a single uniform prescription drug PA form for most drugs (RS 22:1006.1), with exceptions for specialty drugs and e-prescribing.
Denials must explain appeals
Adverse determinations must include clinical rationale and instructions for internal appeal under RS 22:2401.
Where to look up PA rules
PA is handled by the issuer on the ID card. Common Louisiana Marketplace carriers:
- Blue Cross Blue Shield of Louisiana: bcbsla.com
- UnitedHealthcare: uhc.com
- Ambetter from Louisiana Healthcare Connections: ambetterhealth.com
- CHRISTUS Health Plans: christushealthplan.com
- Vantage Health Plan: vantagehealthplan.com
Enroll at HealthCare.gov.
Healthy Louisiana
Healthy Louisiana MCOs set PA under LDH contracts. Service denials: MCO appeal first, then state fair hearing—see LDH appeals.
If PA is denied
- Get the denial in writing with reasons and appeal instructions.
- Ask the treating clinician for records and a medical-necessity letter.
- File an internal appeal by the deadline — Louisiana internal appeals.
- If still denied, request external review with your issuer within 4 months.
Urgent care
Use the 2-day / 48-hour urgent PA rules. For urgent denials, request an expedited internal appeal and, if needed, expedited external review (Louisiana external review). Louisiana law allows simultaneous expedited internal and external review in some urgent cases (RS 22:2433).