Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Louisiana program

Deadlines for an insurer to answer a treatment request

Louisiana sets response deadlines for certain treatment requests sent to state-regulated health plans.

What it is

Louisiana sets response deadlines for certain treatment requests sent to state-regulated health plans.

A treatment request can have a shorter response deadline when the clinic identifies it as cancer-related. Urgent requests and requests to skip a required first medicine use different clocks. The plan type and information received affect which deadline applies.

Eligibility rules
  • The state deadlines cover the issuers named in each statute. Self-funded employer plans generally follow separate federal rules.
  • The cancer and step-therapy laws name the Office of Group Benefits. Continuity-of-care rules name specified nonfederal government plans. Limited-scope dental and vision entities are excluded.
What you get
  • A five-day standard response deadline for a clearly marked cancer request.
  • A two-business-day response deadline for an urgent request.
  • A decision on skipping a required first medicine within 72 hours, or 24 hours when urgent.
What the help covers
  • For cancer requests, the additional-information rule is two business days after requested information arrives. For urgent requests, that clock is 48 hours.
  • Ordinary standard requests have a five-business-day rule. Cancer’s five-day standard is stated separately.
  • If a clinician leaves the network, the social worker can help the insurer identify the applicable continuity-of-care rule. The insurer should confirm the permitted treatment period, scope and clinician agreement in writing for the actual case.
If you decide to apply
  1. Ask the clinic which request it sent, whether it was marked cancer-related and when the plan received it.
  2. Have any request for more information and the treatment or medicine name ready.
  3. Ask the social worker to help compare the plan’s response with the applicable deadline.

The plan; the Department of Insurance on complaint: 800-259-5300

After you apply
  • A plan must answer a cancer-marked request within five days, an urgent request within two working days, and a request to skip a "try this drug first" step within 72 hours (24 when urgent). If it misses the drug deadline the exception counts as approved; if it misses the others it cannot refuse for lack of approval.
  • If the plan needs more information it must say so within a day and give the clinic at least two working days to answer.
Good to know

A late step-therapy exception can count as approved. A missed ordinary deadline has a different remedy and does not automatically make every treatment covered.

Other details
  • The selective prior-authorization program leaves participating doctors and services to insurer discretion. Pharmacy is excluded. It does not automatically exempt every request.
Official sources
Ask your social worker

“Which response deadline would apply to my child’s treatment request? Could you explain the available remedies and help us request a review if the plan is late or refuses?”

Why I’m asking: I want to understand how delays are handled and what the clinic needs to document.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Note the date the request went in and call the plan the day the deadline passes.

Your social worker

The clinic marks the request as cancer-related and sends any extra information quickly.

The care team

The oncologist supplies the clinical detail the plan asks for.

Who decides
The plan, within the published deadline.
Ask the care team
“Can you mark this request as cancer diagnosis and treatment, so the shorter Louisiana clock applies, and tell me the date it went in?”

How to apply

First step: Ask the clinic to mark every request cancer-related and to tell you the date it was submitted.

  1. Ask the clinic to mark every request as cancer diagnosis or treatment.
  2. Ask the clinic to calculate the applicable deadline from the plan’s receipt and any information-request dates, including the correct calendar or business-day rule.
  3. If a step-therapy override is late, say in writing that the statute treats it as approved.

Where it starts: Ask the clinic to mark the request cancer-related, then hold the plan to the published deadline.

What to gather

  • The date the request went in
  • The name of the drug, scan or treatment
  • Any letter asking for more information

How long: For covered Louisiana-regulated requests, cancer-marked requests have an initial five-day deadline and two business days after requested information arrives. Urgent requests use two business days, or 48 hours after requested information. Ordinary standard requests use five business days. Step-therapy overrides use 72 hours, or 24 hours when urgent, with deemed approval for a missed deadline. Scope and receipt dates matter.

What a yes looks like

An authorisation number and a date the approval runs from.

What a no looks like, and the next move

A late step-therapy override is treated as approved under its statute. The ordinary prior-authorization statute separately prevents denial solely for lack of authorization when its deadline is missed. The clinic can identify the applicable rule and appeal route.

Watch out

  • The cancer clock only runs when the doctor has clearly marked the request cancer-related.
  • Private self-funded ERISA plans are generally outside these state insurance mandates; government or church arrangements require a separate scope review.
  • The selective-authorization programme is not an automatic pass: the insurer chooses who is in it, and pharmacy is out.

If they say no, quote this: R.S. 22:1060.13 governs cancer requests; 22:1053 governs step-therapy overrides; 22:1020.61 governs selective prior-authorization exemptions. Ordinary deadlines and the consequence of a missed deadline are in 22:1260.44.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Cancer requests answered in five days; urgent requests in two business days; a step-therapy override in 72 hours, or 24 when urgent, and approved by default if the plan misses it.

  • $5 — Days for a standard cancer prior-authorization decision
  • $2 — Business days for an ordinary urgent decision
  • $5 — Business days for an ordinary standard decision
  • $72 — Hours for a step-therapy override decision
  • $24 — Hours for an urgent step-therapy override decision

Legal protection: A cancer-marked prior-authorization request decided within five days, or two business days after requested information · An urgent request decided within two business days, or 48 hours after requested information · A step-therapy override decided in 72 hours, 24 when urgent, and treated as approved if the deadline is missed · For a departing clinician, ask the plan which continuity-of-care rule applies and for the exact end date in writing.

What it costs the family: None.

The eligibility facts, as published

Plans
Scope varies by statute. The cancer and step-therapy provisions name the Office of Group Benefits. Private self-funded ERISA plans are generally outside state insurance mandates; government or church arrangements require separate review. The plan confirms any applicable continuity rule.
Cancer condition
the requesting provider must clearly indicate the request relates to cancer diagnosis or treatment
Excluded
limited-scope dental and vision entities
Statute refs
R.S. 22:1260.44, 22:1020.61, 22:1060.13, 22:1053, 22:1019.1

The trap: The cancer clock only applies when the requesting doctor has clearly marked the request as being about cancer diagnosis or treatment. Ask the clinic to do that every time.

Where I read this

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