This is also sometimes known as pre-authorization. This means you will have been given authorization or a certiﬁcate to say that you can have a certain medical procedure or a prescription drug. This pre-certiﬁcation may be needed for some procedures where the insurance company needs certain criteria to be met before the treatment schedule can go ahead. It may require your doctor to submit notes and test results to your insurance company before the treatment.
There are also times when pre-certiﬁcation is used to describe the process where a hospital contacts an insurance company prior to your admission to hospital. The aim here is to seek authorization from them for the admission to go ahead; in essence, seeking assurance that funds are in place to cover medical fees.
Each company deﬁnes its own criteria for which treatments need to be pre-certiﬁed in advance, as well as the minimum timeframe for carrying out such pre-certiﬁcation requests.
If pre-certiﬁcation is not made and treatment is received, the insurance company will usually impose a penalty of between 20-50% of the total cost of the treatment, which they will not cover.
In emergency cases, companies allow you to receive treatment without pre-certiﬁcation, informing them only once the emergency has been settled.
It is important to note that with all insurance companies, air ambulance evacuation always requires pre-certiﬁcation and should be activated only by the insurance company.