I Need A Precertification. What Is That?

A precertification is a process of confirming medical necessity and collecting information prior to inpatient services and other specialty types of services.  Without a precertification for these services, your health plan may not provide coverage and may deny any claims related to these services.  Some providers may list a precertification procedures list online.  If you are going through a network facility, the facility should automatically do a precertification.  However, that is not always the case.  If a precertification was not done and your claim is denied, often a retro precertification can be submitted.  When these types of services are done, it is up to the doctor to prove that the procedure was medically necessary.  Each carrier has a specific list of criteria that must be met in order to deem a procedure medically necessary.  If you have any questions about a precertification that is needed or your services are being denied, you can always call the number on the back of your ID card to seek help.  As always, our Customer Care Team is here to help as your advocate.