Pre-certification
What Does Pre-certification Mean?
Pre-certification is the process through which a patient obtains authorization from their insurer to receive a specific prescription drug or healthcare service. It confirms that the insurance company is willing to cover the cost of the medical services in question. However, it’s important to note that pre-certification does not guarantee coverage. Without it, there is no chance of the insurer covering the procedure, treatment, or medication.
This process may also be referred to as pre-authorization.
Insuranceopedia Explains Pre-certification
The health insurance company may require the healthcare provider to submit a pre-certification request, which includes an explanation of the need for the service along with other related documentation, depending on the insurer. This process is often necessary for hospital admissions. While certain exams, such as mammograms, do not require pre-certification, others, like MRIs and CT scans, typically do. For other services, the need for pre-certification depends on the specifics of the insurance plan.
