Most insurance carriers require certain procedures to be pre-authorized or pre-certified. Most medical procedures need an authorization from the insurance company to authorize the procedures before they can be performed, or the patient will incur the cost of the procedure. It’s imperative that the patient check with his insurance carrier for his coverage specifics to avoid denial of the
claim or procedure.

Pre-certification is a clerical administration process submitted by the physicians office or surgical center, listing the treatment plan to the insurance company or third party before any treatment is performed for authorization.
The insurance company or third party will review for medical necessity of the prescribed treatment plan. This process does not guarantee eligibility for treatment or payments.