What is Pre-Certification?
Pre-certification is essentially letting the insurance carrier know of a doctor recommended procedure you would like to have done. The insurance carrier can then look at the procedure and your medical history and decide whether or not to cover that specific procedure. In some cases, the procedure could be denied in favor of a less risky procedure that they will then ask you to do instead. Doctors can fight the denials by filing a claim stating that the procedure is the only one that will work if that is the case. Getting a pre-certification approved means that you will know that your procedure will be covered by the claims department of your insurance policy.
Do I Need a Pre-Certification Request?
You only need to get pre-certified if there is a procedure your doctor recommends for you that the insurance carrier asks for pre-certification requests. These are usually higher risk procedures like surgeries and hospitalizations. Most minor procedures and doctor visits do not need to be re-certified in order to be covered. Read through your plan materials to decide the best course of action to take for you. You can usually find out which procedures require a pre-certification request before the procedure takes place. Going ahead with a procedure that needs prior certification without having the certification could result in the denial of the claim. If you aren’t sure if you need one and can’t find the answer in your insurance materials, call your insurance carrier for clarification. You can also send in a request just in case.
Should I Get a Pre-Certification Request?
If you are recommended a procedure that requires pre-certification, you should go ahead and do the paperwork for it. By filing the paperwork, you will find out before you have the procedure if your insurance company even covers it. The insurance company will be able to determine if the procedure is necessary at all. When you are in a foreign country, the second set of eyes on the recommendation is probably a good idea. And the pre-certification process will also help you find the best hospital and doctor to perform the procedure if it’s approved. This will help keep your costs low.
When it comes to a major medical procedure, pre-certification is the way to go. It will give you peace of mind in knowing that you are doing what is right for you and your health. It will also help to know that it is covered by your insurance carrier. If you are recommended to have a procedure and you are not sure if it’s the best course of action, sending in a pre-certification request can help you answer your questions. For minor procedures and doctor’s visits, it’s not required that you do a pre-certification, but when in doubt you should send it just in case.
Published on August 7, 2019
