Question:
What's the difference between precertication and approval by an insurance carrier?

My surgeon is in the process of submitting all my medical records (about 2 inches thick of paperwork) to Cigna for predetermination/precertification. <br> What's the difference between predetermination/ precertification and approval? <br> I have Cigna HMO and wondered if anybody had experience of being precertified and not getting final approval. <br> Thanks for any suggestions.    — Deborah N. (posted on November 20, 2002)

November 21, 2002
Predetermination is when the medical personnel review your medical records to see if you meed the qualifications stipulated in the contract with your employer (if your employer is selfinsured, the surgery could be excluded; precertification is when the provider contacts the health services area to say what cpt codes they are going to be performing, when, if your going to be inpatient or outpatient and how long of a stay will be required; approval comes after the predetermination process. You'll receive a letter saying you have been approved for the surgery and the nurse will place a referral in the computer to see that all of your claims are processed. Hope this helps!
   — Becky S.