This week we review a recent thought-provoking work on the topic of the dreaded 'pre-authorization' process for procedures being performed in the US. Are there data to support the costs in money and time associated with this process in the world of congenital cardiology? How often are authorizations denied in congenital cardiac cases? Is there any evidence that obtaining insurance pre-authorization improves outcomes? What is the impact of this process on healthcare equity? These are amongst the questions reviewed this week with Dr. Brian Marcus who is a cardiologist and critical care fellow at Children's Wisconsin. 

• DOI: 10.1007/s00246-023-03255-1