La cobertura del seguro queda clara

Coverage depends on whether your procedure meets your insurer's medical necessity criteria — meaning it treats a documented functional impairment, not a cosmetic concern. The best starting point is selecting your procedure below and reviewing what documentation is typically required. Your surgeon's office handles the prior authorization from there.

A procedure is considered medically necessary when it addresses a documented functional problem — chronic pain, restricted movement, obstructed vision, breathing difficulty — rather than appearance alone. Insurers also require evidence that conservative, non-surgical treatments were tried and failed before approving surgery.

Denials are common on first submission and can often be overturned on appeal. Your surgeon can submit additional documentation, request a peer-to-peer review with the insurer's medical director, or provide supplemental clinical evidence. Many initial denials are successfully reversed with a stronger authorization package.

Some plans require a referral from your primary care physician before seeing a specialist. Check your plan's requirements early — this step is easy to overlook and can delay your authorization timeline if it's missed.

Standard prior authorizations typically take 5–14 business days from the date of submission. Your surgeon's office manages the submission and follows up with your insurer. Having complete documentation ready before submission — clinical notes, imaging, treatment history — is the single biggest factor in how quickly a case moves.