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.

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