Question:
Certification vs. Approval?

My doc told me I was certified but they were waiting for the approval letter to set a date. But my insurance company says they don't precertify this surgery but it will be covered 100% if the doc deems it necessary. Huh? I'm not sure what's going on? Any ideas, explanations, suggestions?    — Brigid M. (posted on June 5, 2003)

June 5, 2003
You're very lucky if you don't have to pre-cert inpatient stays!.. most policies require precerts for inpatient stays, and many require pre-certs for various out patient procedures as well... but back to your question :) It sounds like perhaps your doctor submitted a pre-determination to the insurance... this is a list of diagnosis codes and procedure codes, the insurance company reviews it and makes a determination of what/how they will pay for the procedure if nothing changes (or at least that's how it is supposed to work). But, without seeing the forms or the response, I can't tell if this is what was done or not. I hope this helps a little though. Lots of luck!!
   — Kimberly J.

June 5, 2003
Thanks! That does make sense. :)
   — Brigid M.