Question:
HELP will someone please explain the difference between pre-approval

and pre-determination. Told I need both before surgery.    — postonch (posted on May 25, 2009)

May 25, 2009
Hi Cathy, I dont know what the diff is between the two. I know that the Dr. (PC) had to see me every month for weight loss. It ment we talked about it..he asked if I was eating correctly, weighed me,recomended medication for weightloss. My surgeon.. set up ALL the preliminary tests to be done. Sleep study, cardiac, chest xray, a psychi eval. We had everything done so that when my year (that is what my ins. wanted) I was all set to get my auth. My surg. send in the request to the ins. and we had a approval 2weeks later! I believe the pre determination would be for a DR. to say you need the surg..then work on the pre-reqs for surg. Are you useing a Bariatric surg DR.? They will know what to do when. Hope I was a little help.
   — tootsie52

May 25, 2009
I think the pre-determination is to figure out if you really need the surgury. I've been pre-approved for surgury(August 26) It will become definite when the insurance company gets all the paper work from the predetermination work of my pcp, surgeon, and anything else that I had to do. I hope this helps.
   — Kathleen W.

May 25, 2009
pre-apporoval is when the doctors office calls and finds out if you procedure is covered under your insurance and the insurance company gives them a pre-approval pending the required thing are completed.
   — Katie D.

May 27, 2009
Hello, PREDETERMINATION OF BENEFITS The predetermination of benefits process allows the medical provider -- at the consumer's request -- to send the insurance company a statement listing a proposed treatment or test, or the proposed purchase of medical equipment. Within a few weeks, the insurance company will generally respond with a statement of the amount of reimbursement the company will usually provide for that test, procedure, or equipment. Pre-Approval Some health insurers require pre-approval, also known as pre-certification, for certain types of healthcare services, such as surgery or hospital visits. This means that you or your doctor must contact your insurer to obtain their approval prior to receiving care, or else the insurer may not cover it. Not all services will require pre-approval, but if you are in doubt, it's best to contact your insurance company in advance of obtaining any type of health care. Hope this helps, please check out my OH page for more tips and useful information or contact via email I'm just a click away! StrangePassion XOXO
   — StrangePassion