What is Pre-Certification and Why Do I Need it?
Pre-certification also known as prior authorization, is the process of obtaining approval from the travel insurance company to receive a particular medical service, treatment, or prescription drug. Pre-certification is always required for medical procedures such as scheduled surgery, hospitalization, and MRI and CAT scans that a traveler may need in the event of an unexpected illness or injury abroad. If a policyholder wants to utilize their coverage, and it's not an emergency where care is needed immediately, they should reach out to the carrier for pre-certification.
Why is Pre-Certification or Prior Authorization Required?
Pre-certification or prior authorization is important for certain procedures or medication due to the following reasons:
- Pre-certification helps determine if the procedure or treatment is medically necessary and if it is covered by the policy.
- This is beneficial to both the insurance company and the policyholder as pre-certification helps control medical costs by encouraging the patient and physician to follow the policy terms to make a more cost-effective decision regarding the treatment.
- The pre-certification process assists the patient in finding a physician or hospital to perform the medical procedure and negotiates treatment rates with the healthcare provider.
Failure to obtain pre-certification may result in a financial penalty or denied claim. If a covered treatment is not pre-certified, the insured may face a 50% reduction in benefits.
How Does the Pre-Certification Process Work?
To obtain pre-certification for an urgently-needed treatment, the patient or physician must contact the travel insurance company to inform them of the planned procedure. No formally written request is necessary; only a phone call to the insurance company is necessary to pre-certify.
The policyholder can find a contact number of a representative from the insurance company on their visitors insurance ID card. The call must be made at least 48 hours before the procedure or as soon as reasonably possible in the case of a medical emergency that requires you to visit urgent care or the emergency room.
Each travel insurance company or visitors insurance plan has its own specific list of treatments or services that require pre-certification. Refer to your policy documentation to verify which procedures must be pre-certified before receiving any service.
What Happens After Pre-Certification and Approval?
After obtaining approval for pre authorization from the insurance company, be sure to notify the physician or hospital at which you are receiving the treatment.
Pre-certification is only a determination of medical necessity; it does not guarantee payment or claims reimbursement. You must still be eligible for the treatment, and the treatment must be a covered benefit as per the policy terms.
Pre-certification is just one part of how visitors insurance works; don't forget to take the other necessary steps of the insurance process. There's several other important factors to look into when buying visitors insurance. We've compiled a list of 5 Key Factors when deciding on Visitors Insurance.