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

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Montana program

How fast the plan must answer a prior authorization

Montana sets deadlines for insured plans to decide whether to approve treatment in advance.

What it is

Montana sets deadlines for insured plans to decide whether to approve treatment in advance.

Waiting for a plan can delay care. Montana places clocks on covered requests. Completeness and clinical urgency affect the clock.

Eligibility rules
  • State rules cover issuers offering health plans and performing utilization review.
  • For a covered Montana insurance policy, standard prior review is generally due within seven business days; one extension of up to seven business days needs a qualifying reason and timely notice. A request for missing information must identify what is needed and must give the family at least 45 days to respond. Urgent review generally has a 48-hour decision clock, with a 24-hour missing-information notice, at least 48 hours to supply it, and a decision within 24 hours after the response or its deadline. Your social worker can help confirm the plan's regulator and the exact clock, including for a public or self-funded plan. The insurance office can also check whether a prior-review exemption or step-therapy exception applies.
What you get
  • A decision deadline you and the clinic can check.
What it covers
  • The plan has 24 hours to identify missing information for urgent requests.
  • The clinic’s medical explanation supports urgent review.
If you decide to apply
  1. Ask the clinic and plan when the request arrived and when an answer is due.
  2. Bring the date, reference number and plan booklet, and ask the clinic to explain any clinical urgency.

1-800-332-6148 — Montana Commissioner of Securities and Insurance consumer assistance · Official page ↗

After you ask
  • A decision can approve or deny care. Denials follow the applicable appeal route.
Good to know

The ordinary clock can have a further seven-business-day extension. Incomplete requests have additional rules.

Other details
  • The 48-hour urgent clock differs from the 72-hour expedited external-review clock.
Official sources
Ask your social worker

“Which clock applies if treatment waits on the plan? What could extend it, and could you help seek urgent review if waiting is unsafe?”

Why I’m asking: I want to know when an answer is due and what we can do about delays.

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

Ask for the decision date in writing and chase it.

Your social worker

The clinic sends the request and marks it urgent when it is.

The care team

Marks the request urgent and sends anything missing the day it is asked for.

Who decides
The insurer, within the statutory clock.
Ask the agency
“When is the decision on this prior authorization due? My child is in cancer treatment, so please treat the request as urgent.”

How to apply

First step: Ask the plan, in writing, when the decision is due, and ask the clinic to mark it urgent.

  1. Ask the plan in writing when the decision is due.
  2. If treatment cannot wait, ask the clinic to mark the request urgent.

Official application / program page ↗

Where it starts: Ask the plan, in writing, when the decision is due and name the deadline.

What to gather

  • The date the request was sent
  • The clinic’s reference number
  • The plan booklet

How long: Seven business days ordinarily; 48 hours when urgent.

What a yes looks like

An approval within the clock.

What a no looks like, and the next move

A denial: then the external review route opens, with 120 days to ask.

Watch out

  • The clocks have conditions; send anything the plan asks for the same day.
  • Self-funded and government plans are not settled by these rules.

The numbers and the rules

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

What it is worth

Seven business days for an ordinary decision, a possible further seven, 48 hours when urgent and 24 hours to name missing information.

  • $7 — Business days for an ordinary prospective decision
  • $7 — Further business days the statute allows as an extension
  • $48 — Hours for an urgent decision
  • $24 — Hours to tell you information is missing on an urgent request

Legal protection: Decision clocks on prior authorization for insured plans

What it costs the family: None.

The eligibility facts, as published

Plan type
issuers offering a health plan and performing utilization review; self-funded and public-plan applicability was NOT FOUND

The trap: These are the ordinary clocks with conditions attached, not a promise for every incomplete request. Send everything the plan asks for the day it asks.

Where I read this

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