Question:
Does anyone know the difference between insurance authorization and pre-certification

I called my insurance carrier today and they said they have the authorization (yipeeeee!!!) then I called the surgeons office to find out what I needed to do next and they said that they were waiting for pre-certification. I thought that's what the authorization was for. Does anyone else know. Thank you    — chilin1106 (posted on September 21, 2004)

September 21, 2004
I had the same thing happen and I freaked...All it meant for me was the surgeons office had not heard from the insurance company yet..Good luck and enjoy the journey. It is sooooo worth it.
   — Kathy S.

September 21, 2004
Dear Laurie, I think they both mean the same thing. Sounds like Dr's. office has not gotten the word from insurance yet...
   — Donna Y.

September 21, 2004
It is the same thing. Have your insurance co fax the authorization to the doctors office or have the doctors office call your insurance. You can even call you insurance yourself and get the auth number. That is all the your doctor needs. Good luck and congrats on getting approved! You will do great! Get ready for a change of your life!
   — Erin E.

September 22, 2004
Your insurance company should send either to your primary or the doctor who is going to be doing the surgery a referal notice. This is usually good for 60 days. This gives the doctor the go ahead to do the surgery. I have Blue Cross Blue Sheild of Ill. Good Luck!
   — Linda R.

September 22, 2004
Hi. I was told that the authorization just means that your insurance does cover weight loss surgery in general. The pre-certification actually means that the insurance will cover your specific weight loss surgery. I also had the same thing happen to me. I called my insurance company and they told me I was approved. When I called my doctor's office they said I wasn't approved yet and couldn't schedule my pre-op appointment. Then a few days later my surgeon's office called to tell me that I was approved and scheduled my pre-op appointment. So it may take a few days for your insurance company to get word to your doctor's office. Best wishes for a safe and successful surgery soon.
   — Donna F.

September 24, 2004
Hi, I'm no expert, but here's my 2 cents: PRE-DETERMINATION: this is checking to see if WLS or PS is even in your policy. You could have an "exclusion" which simply means they won't do it no matter what. PRECERTIFICATION: this is the process of the doc sending in a "letter of medical necessity" that gets rewiewed and hopefully approved. Some companies will give you a AUTHORIZATION number, some will not. But a successful auth letter means "go ahead" even though if you read the fine print, it says that "this is no guarantee of payment." Hope this helps.
   — DrL