Prior authorization at Regence: balancing the needs of all so you get quality care that’s cost-effective

Roughly one-third of Americans say they’re cutting back on other daily living expenses to afford healthcare, according to a Gallup poll earlier this year. Many people are feeling the pinch.

Regence fights every day to hold down healthcare costs. Prior authorization helps us identify the most cost-effective care option for you without compromising quality. It prevents redundant tests, and it flags conflicting diagnoses. It also helps you know what’s covered as part of your benefits, preventing costly surprises. 

You deserve affordable healthcare, and you deserve to know the facts about prior authorization.

MYTH Regence requires prior authorization on many common procedures and treatments. 

FACT Regence health plans processed 49.95 million claims in 2025. They required prior authorization on just 5% of those medical procedures and treatments. In most cases, Regence members don’t need a prior authorization, but we apply it in high-risk, high-cost healthcare decisions.  

MYTH Prior authorization delays necessary care.

FACT Of the total prior authorization requests, 81% get automatically approved in real time at Regence. Your provider receives an answer quickly, often within minutes.

MYTH Insurance bureaucrats make healthcare decisions, not medical practitioners.

FACT Doctors, nurses and other clinical experts such as pharmacists make prior-authorization decisions at Regence. Their expertise informs our medical policies.

MYTH Regence is increasing the number of medical procedures and treatments that require prior authorization.

FACT Regence is decreasing the number of billing codes that require prior authorization for different procedures and treatments. Billing codes are the numbers that providers and insurance companies use to bill and pay for your healthcare. In 2025, we removed 1,423 prior authorization requirements.

MYTH Prior authorization creates administrative burden for my doctor.

FACT Prior authorization isn’t perfect. We’re committed to alleviating administrative burden. And we’re committed to speeding up the prior-authorization process so providers and members don’t wait in limbo.

Our unique, first-in-the-nation SmartAuth tool pre-populates the Regence prior- authorization request form within a provider’s system, pulling information directly from the patient’s electronic health record. This radically reduces the need for manual data entry and speeds up responses because of its accuracy. Of the total SmartAuth requests, 93% receive an immediate response—meaning a request is either approved or no prior authorization is needed—within seconds. Providers using our SmartAuth tool report a 40% reduction in administrative burden and faster processing times and revenue cycles. One provider using SmartAuth went from processing three to five prior authorization requests per hour to 10 to 12.

MYTH  Prior authorization creates so much frustration that people regularly abandon their treatment.

FACT Of the total prior authorization requests, 81% get automatically approved in real time at Regence. Your provider receives an answer quickly, often within minutes. We want members to receive the right care at the right time in the right setting. As a national leader, Regence is committed to using technology to streamline the prior authorization process and to speed up when providers and members get their decisions. In cases where we aren’t able to provide prior authorization, we deliver personalized support through our Customer Service and Care Management professionals: insight into what caused the denial, guidance on navigating the appeals process, and help identifying care options that are covered.

MYTH Regence uses prior authorization because you don’t want to pay for my procedure or medication.

FACT Regence health plans benefit most when you’re healthy. It’s at the heart of our cause, ingrained in our ethics, and it’s in our financial interest to cover the best outcome for you. A responsible insurance company must also consider the financial health of businesses and organizations that offer health insurance and the policyholders who help pay its cost. Unmanaged spending could put our health plans’ economic viability—and thus their ability to pay for your healthcare—in jeopardy. It could also make Regence health plans too expensive for employers and members. We use prior authorization in high-risk, high-cost healthcare decisions to ensure that every healthcare dollar is spent wisely. Regence works diligently to balance the needs of all parties so you’re getting quality care that is evidence-based and cost-effective.

Learn more about Prior Authorization at Regence.