Question:
Pre-approved -OR- Pre-certified -OR- Both??

I received a pre-approval letter from my insurance company awhile ago, and in re-reading it, I see a sentence at the bottom about the need for getting pre-admission certification for inpatient care. I'm taking that to mean that if I am in the hospital for more than 23 hours, it will be considered inpatient care and for the insurance company to pay under those conditions, I will have had to be pre-certified in addition to being pre-approved. I am on the right track with this, yes?? If anyone knows for sure, I'd appreciate hearing from you in reply. I will try to contact my insurance company after the Holidays to be sure. Thanks for any replies.    — Deborah L. (posted on December 27, 2003)

December 27, 2003
Your pre-approval letter should also include a pre-certification. I would call the insurance just in case. If you don't get far with the insurance, try the hospital you will be staying at, they should have a pre-cert staff. If not, call your doctor the nurse should be able to help you! Congrats, Good luck! Heather
   — kitten75751

December 28, 2003
Pre-approved means that the surgery itself is approved. Pre-certification means that they are certifying that the hospital stay is medically necessary and the length of stay requested is appropriate for the procedure. Out-patient (23-hr stay) may or may not require pre-certification. Make sure you check with your insurance company. If your stay is planned for over the 23 hrs, have your drs office or hospital get the stay pre-certified, and if anything happens to extend the stay, make sure they contact the insurance company again to get additional days certified. Hope this helps.
   — lharbison