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
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