Pre-certification/Referral

Each proposed hospital admission and inpatient or outpatient surgery must be Pre-certified for medical necessity, which means the insured person or their attending physician must call the number listed on the insurance identification card prior to admittance to a hospital or performance of a surgery. In case of an Emergency Admission, the Pre-certification call must be made within 48 hours of the admissions, or as soon as reasonably possible. If a hospital admission or a surgery is not Pre-certified, eligible claims and expenses would be reduced by certain percentages such as 20%, 50% that varies by insurance plan. Pre-certification is not an assurance of coverage, a verification of benefits, or a guarantee of payment. All medical expenses must meet usual, reasonable, customary, and eligible payment guidelines.

See Also: Provider; Primary Care Physician or Doctor; Primary Care Physician; Primary care; Preventive care; Preferred Provider Organization (PPO); Policy maximum; Policy duration in travel insurance; Primary provider of benefits; Primary beneficiary;

Get our Quick Quotes: Auto Quick Quote Home Quick Quote Life Quick Quote Health Quick Quote and Apply Online Travel Quick Quote and Purchase Online Insurance in California