Your surgeon has recommended surgery, you've scheduled a date, and you're getting ready for the procedure. But when you ask about insurance approval, the surgeon's office tells you to call the hospital. The hospital tells you to contact your insurance company.
So who's actually responsible for getting your surgery approved?
In many cases, the surgeon's office handles the prior authorization request. But responsibilities vary depending on your insurance plan, the procedure, and the organizations involved. The important thing is finding out who is submitting the request, who is making the decision, and who will tell you when it's complete.
For many planned procedures, the surgeon's office submits the prior authorization request to your insurance company.
The request may include information about the planned procedure, diagnosis, medical necessity, and supporting medical records.
Depending on how the practice operates, the request might be handled by:
In some arrangements, the hospital or surgery center handles authorization for certain services.
There isn't one universal process.
The most useful question is: "Which office is responsible for submitting my surgery authorization request?"
Once you know that, you have a starting point for checking progress.
Your insurance company is responsible for reviewing the authorization request and making a coverage determination under your plan's rules.
The insurer may:
The insurance company may communicate its decision to the requesting provider, the patient, or both, depending on the plan and process.
An important distinction: prior authorization is not a guarantee that every surgery-related charge will be covered or paid.
Your deductible, network status, benefits, and other plan requirements can still affect your final costs.
The surgical facility has its own administrative and financial processes.
It may need to verify your insurance coverage, determine whether authorization is required for facility services, and confirm that the procedure can proceed under its policies.
This becomes particularly important when your surgeon and surgical facility are separate organizations.
For example, the surgeon's office may be responsible for obtaining authorization for the procedure while the facility verifies whether its own services require separate approval.
Don't assume that approval communicated by one organization automatically resolves every requirement.
Ask the facility:
"Has everything required for my surgery at this location been confirmed, or is anything still outstanding?"
Usually, patients aren't expected to prepare and submit the clinical documentation for a surgeon's authorization request.
However, you may still have responsibilities.
Depending on your plan, you might need to:
Some plans and services have different rules, so it's important to confirm your particular requirements.
You can help coordinate the process without assuming responsibility for tasks that require the provider's medical records or clinical documentation.
Being told that an office is "working on it" doesn't necessarily mean the insurance company has received the request.
Ask the team responsible for authorization:
If the office hasn't submitted the request yet, ask what is preventing submission and when it expects to proceed.
If the request has been submitted, you can contact your insurer to verify its status.
For more guidance when a decision hasn't arrived, see My Surgery Is Scheduled, but Insurance Authorization Is Still Pending. What Should I Do?.
This is one of the most frustrating situations patients encounter.
Your surgeon's office may say the procedure is approved while the facility says authorization is missing. Or the insurer may have no record of a request the surgeon's office says was submitted.
Sometimes the organizations are discussing different parts of the same surgery.
Other times, there may be a delay in communication, a missing record, or an incorrect authorization detail.
Start by confirming that everyone is referring to the same:
Then ask the organization that submitted the request to help reconcile the conflicting information with the insurer or facility.
You can say:
"My surgeon's office says the surgery is approved, but the hospital says authorization is still missing. Can you confirm which authorization is required and who is responsible for resolving the discrepancy?"
If necessary, ask whether the authorization team can contact the other organization directly.
Rather than continuing to repeat the same explanation to different departments, try to establish one clear owner.
Call the surgeon's scheduling or authorization team and explain:
"I'm trying to confirm insurance approval for my scheduled surgery. I've contacted several departments, but I still don't know who is responsible for the authorization request. Can you tell me which team owns it and who I should follow up with?"
If the surgeon's office says another organization is responsible, ask for the specific department and contact information.
When you reach that department, confirm that it actually has the request.
If no one can identify the responsible team, ask to speak with an authorization supervisor, surgical scheduling manager, or patient services representative.
The goal isn't to become the intermediary for every conversation. It's to identify the team that can resolve the outstanding issue.
If your surgery is approaching and authorization remains unclear, contact the surgeon's office promptly.
Ask whether the unresolved authorization affects the scheduled procedure and what must happen before surgery can proceed.
For certain insurance programs, federal rules establish decision timeframes for prior authorization requests. But those requirements don't apply identically to every insurance plan, and the relevant clock generally begins when the insurer receives the request.
Don't assume your request is overdue without confirming your plan's requirements and submission date.
If the delay could affect medically necessary care, tell your surgeon's office so the clinical team can determine whether additional action is appropriate.
If the insurer denies authorization, ask for the specific reason and written denial information.
Your surgeon's office may be able to correct an error, submit additional documentation, request reconsideration, or help with an appeal.
Your appeal rights and deadlines depend on your insurance coverage.
A denial doesn't necessarily mean the surgeon no longer recommends surgery, but it may affect whether the procedure can proceed as scheduled.
See My Surgery Was Denied by Insurance. What Do I Do Now? for the next steps.
Preparing for surgery involves a lot of small but important steps. Download the free SurgiNav Surgery Prep Checklist to stay organized and feel more confident before your procedure.
The surgeon's office often handles the insurance authorization request, while the insurance company makes the coverage decision. The hospital or surgery center may also have its own requirements to verify.
But the exact responsibilities vary.
If you're getting conflicting answers, focus on three questions: Who submitted the request? What is its current status? Who is responsible for the next step?
You shouldn't have to guess which organization is handling your surgery approval. Identifying the responsible team can help you get clearer answers before your procedure.
Preparing for surgery can feel overwhelming, but you don't have to remember every detail on your own. Download the free SurgiNav Surgery Prep Checklist to stay organized, avoid common mistakes, and feel more confident before surgery day.
Download the Free Surgery Prep ChecklistThis article provides general educational information and is not a substitute for medical advice. Always follow the instructions provided by your healthcare team.
Prepare
Surgery Day
Recover
Resources
About
© 2026 SurgiNav
Educational information only. Always follow your surgeon's instructions.