Rejected authorization in private insurance: step by step
A rejection does not close the case
Many rejections recover if the clinic acts fast with the right information. Read the literal denial reason, do not summarize it. ASISA publishes four common reasons; not all of them are fixable the same way.
Calculate revenue lost to authorisations
Use the SaludComply authorisation diagnostic to estimate monthly loss, recoverable range and operational complexity. No patient data required.
How to classify the rejection in 60 seconds
Four families: documentary, clinical, coverage and timing. Only the documentary family normally resolves through a corrected resubmission without clinical escalation.
How to prepare a resubmission that can actually be approved
Quote the original rejection with its reference. Attach the missing document or the precise correction. Repeat the code as it appears in the policy. Do not resubmit from scratch unless the insurer requires it.
When it stops being worth the effort
If the reason is coverage, waiting period or arrears, no resubmission will fix it. Communicate honestly, offer a private quote and document the case.
Frequently asked questions
- Does a rejected authorisation close the case?
- Not always. Many rejections recover if the clinic responds quickly with the right information, starting by reading the literal denial reason rather than summarising it. ASISA, for example, publishes four common reasons: service not covered, waiting period not met, prescriber not authorised and premium arrears. Not all of them are fixable the same way.
- Which rejections can be corrected with a resubmission?
- Only documentary rejections —missing report, absent signature, wrong code or outdated patient data— resolve through a corrected resubmission without clinical escalation. Clinical, coverage (service not covered, active waiting period, suspended policy) or timing rejections usually need another conversation. The agent distinguishes recoverable from coverage rejections from the first step so the queue does not fill with impossible cases.
- How do you prepare a resubmission that can actually be approved?
- Quote the original rejection with its authorisation number or internal reference, attach the missing document or the precise correction and repeat the code and procedure exactly as they appear in the policy. If the reason was clinical, ask the clinician for a short note justifying necessity. Do not resubmit the whole case from scratch unless the insurer requires it, because it lengthens the window and erases the trail of the prior request.
Verified sources
- ASISA — Me han denegado una autorización — motivos oficiales de denegación
- Adeslas — Autorizaciones — proceso oficial y caducidad
- DGSFP — Memoria del Servicio de Reclamaciones 2024 — contexto regulatorio sobre rechazo del siniestro