Which procedures need prior authorization in private insurance
Short answer: expensive or complex procedures usually need authorization
In private health insurance, prior authorization usually appears in high-cost or high-coordination acts: surgery, hospitalization, MRI, CT, PET-CT, scintigraphy, rehabilitation, psychotherapy, oncology, endoscopy and special treatments.
Diagnostic tests: MRI, CT, PET-CT and scintigraphy
ASISA states that CT, MRI, PET, scintigraphy, vascular/interventional radiology and nuclear medicine require authorization. MAPFRE distinguishes basic tests from non-routine diagnostic tests such as MRI and endoscopy.
Surgery and hospitalization: authorization before booking capacity
Surgery and hospitalization are the sensitive cases. ASISA confirms that all surgery, including ambulatory surgery, needs prior authorization. Adeslas publishes a general 30-day validity and longer windows for some waiting-list surgery cases.
Rehabilitation, physiotherapy and psychotherapy: the risk sits in renewals
Rehabilitation and physiotherapy often run in session blocks. The risk is not just the first referral; it is renewal timing, billing with the right authorization number and avoiding sessions outside the authorized window.
Oncology and special treatments: do not improvise with the portal open
ASISA includes all oncology treatments among services requiring authorization. MAPFRE mentions special cardiology and oncology treatments. The clinic needs clinical report, prescription, site, date and status clear before moving capacity.
Verified sources
- ASISA — Qué servicios tengo que autorizar — lista oficial de servicios con autorización
- ASISA — Cirugía ambulatoria y autorización previa — cirugía ambulatoria requiere autorización
- MAPFRE — Prestaciones que necesitan autorización — categorías de pruebas y tratamientos
- Adeslas — Autorizaciones — caducidad general y tramitación en área cliente
Related pages
Calculate revenue lost to authorisations
Use the SaludComply authorisation diagnostic to estimate monthly loss, recoverable range and operational complexity. No patient data required.