Pre-Authorization vs. Pre-Certification

Danyellenr
on 10/15/07 7:22 am - Los Angeles, CA
What is the difference between the two.  I was approved for the surgery last week.  Now my surgeon's office is requesting additional information for the pre-certification. It looks like the pre-authorization was through the insurance company and the pre-certification is through an outsde agency?   does anyone have any hekp for me?


                  

Kerri G.
on 10/16/07 1:21 am - Overland Park, KS
Pre-authorization is the 1st step to getting your procedure done The surgeon's office sends the info in & waits for approval.  It basically tells them that if you have this procedure done it will be covered. Pre-Certification, is the authorization for your inpatient stay at the hospital.  Pre-cert is done usually by the insurance company, sometimes they will use an outside agency but not usually.  They certify the days that you will be in the hospital, and extend if needed.  This has to be done with  all insurances (except Medicare)  for all hopsital stays except labor & delivery stays. Hope this helps Kerri
Danyellenr
on 10/17/07 5:37 am - Los Angeles, CA
Thank you so much for your explanation! I did not need any of those requirements after all.  The surgeons office sent over my complete file for the pre-certification and it was approved. Thank you!


                  

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