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

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Washington program

When treatment is waiting on insurance approval

For plans under Washington law, a complete electronic request must be answered in 3 calendar days (holidays excluded), 1 when urgent; other routes get 5 and 2.

What it is

For plans under Washington law, a complete electronic request must be answered in 3 calendar days (holidays excluded), 1 when urgent; other routes get 5 and 2.

Prior authorization means the insurer wants to approve something before it pays. For Washington-regulated plans, a complete electronic request must be answered within three calendar days excluding holidays, or one day when urgent; other submission routes have five and two. Whether these clocks bind your plan depends on how it is funded, so ask HR once.

Which plans and how counted
  • Carrier plans issued or renewed on or after January 1, 2024; a private employer’s self-funded plan generally follows different rules.
  • The request must contain the necessary information; missing information can change the deadline.
  • A step-therapy exception has its own clock: three business days, one when urgent. If the plan does not respond in time, the exception is treated as granted.
What you get
  • A deadline the care team can hold the insurer to.
  • A complaint route through the insurance commissioner if it is missed.
What it is not
  • A timely answer is not a guaranteed approval.
If you decide to apply
  1. Ask the team for the request date, whether anything is missing and the insurer’s reference number.
  2. Ask which deadline applies and whether clinical urgency warrants expedited review.
  3. If a deadline is missed, ask the insurer for a written response and contact the insurance commissioner.

Office of the Insurance Commissioner · Official page ↗

Records
  • Keep the receipt date and reference number; ask for a written decision.
Good to know

The treating team establishes urgency. Fax is not automatically the designated electronic process.

Other details
  • Government and church plans need their own classification.
Official sources
Ask your social worker

“If an approval is delayed, can the team tell us when the complete request went in and which deadline applies to our plan?”

Why I’m asking: We want the care team to identify the correct deadline and next step.

More background and detailed requirements

How this could help

Prior authorization means the insurer wants to approve something before it will pay. First ask the care team whether the request is complete and when the insurer received it. Missing information can change the deadline.

For applicable Washington-regulated plans, the current designated-electronic standard is three calendar days excluding holidays, or one calendar day for urgent requests containing the necessary information. Other submission processes use five standard or two urgent calendar days. The treating team establishes medical urgency.

What to know before you apply

  • The rule does not promise that the insurer will approve the requested care; it requires a timely response.
  • A step-therapy exception asks to bypass trying another medicine first. The usual state deadline is three business days, or one business day when urgent.
  • Plan type and the kind of request matter. A private employer’s self-funded plan generally follows different rules.
  • Fully insured does not necessarily mean Washington-regulated. Ask for the actual policy’s jurisdiction and administrator; government and church plans require their own classification.

Your next steps

  1. Ask the team for the request date, whether anything is missing and the insurer’s reference number.
  2. Ask which deadline applies and whether clinical urgency warrants expedited review.
  3. If a deadline is missed, ask the insurer for a written response and contact the insurance commissioner about the applicable complaint route.

carrier plans issued or renewed on or after January 1, 2024; the ordinary definition excludes a private employer's self-funded plan

Washington-regulated coverage

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 clock by name and note the date the plan had everything.

Your social worker

The plan answers inside the published clock.

The care team

The team files the request electronically and marks it urgent.

Who decides
The health plan.
Ask your social worker
“What is holding up the authorization, and does the medical situation qualify for an urgent response?”

How to apply

First step: Ask the team for the request date, whether anything is missing and the insurer’s reference number.

  1. Ask the team to file electronically and mark it urgent.
  2. Ask the plan what information is still missing, since the clock runs from then.
  3. If the clock passes, complain to the insurance commissioner's office.

Official application / program page ↗

Where it starts: The oncology team files the request. Ask them to file electronically and to mark it urgent where waiting would harm your child.

What to gather

  • The date the request went in
  • Anything the plan says is missing

How long: Three calendar days standard, one urgent, on a complete electronic request.

What a yes looks like

An authorisation number and a date.

What a no looks like, and the next move

If the clock runs out, complain to the insurance commissioner's office and ask the plan for its decision in writing.

Watch out

  • The clock starts when the plan has everything, so ask what is missing.
  • Marking a request urgent is what turns three days into one.
  • A private employer's self-funded plan is outside these rules.

Dates that change this

2027-01-01: A different version of this statute takes effect in January 2027; the clocks here are the current text and should be checked again then.

The numbers and the rules

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

What it is worth

Three calendar days for a complete electronic request, one when urgent; five and two on paper. Step-therapy exceptions in three business days, one when urgent.

  • $3 — Calendar days for a complete electronic request
  • $1 — Calendar days for an urgent electronic request
  • $5 — Calendar days for a request that is not electronic
  • $2 — Calendar days for an urgent request that is not electronic
  • $3 — Business days for a step-therapy exception
  • $1 — Business days for an urgent step-therapy exception

Legal protection: The plan has to answer inside the published clock once it has the information it needs

What it costs the family: Nothing.

The eligibility facts, as published

Plan type
carrier plans issued or renewed on or after January 1, 2024; the ordinary definition excludes a private employer's self-funded plan
Residency
Washington-regulated coverage

Decisions this site cannot make: Prior-authorization determination

Expect friction on: Getting the request filed electronically

The trap: The clock starts when the plan has everything it needs, so ask what is missing and get it sent the same day. The step-therapy clock is in business days; the prior-authorization clock is in calendar days excluding holidays.

Where I read this

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