In most visitors medical insurance and travel health insurance policies, there is a requirement for pre-certification (for medical necessity) in case of hospitalization or surgery. Pre-certification is basically a permission you need to obtain???written or oral???from the insurance company before a said procedure is performed. This is a tool used by the insurance provider to control unnecessary medical procedures.
In addition to hospitalization and surgery, some insurance providers insist on pre-certification for outpatient procedures also. Please read the document carefully before purchasing the policy. Before a medical procedure is performed, your representative, doctor or hospital is required to call up the insurance company with details. Health insurance companies may ask for medical procedure codes to ascertain whether the same is covered in the insured???s plan.
Pre-certification has to be generally obtained prior to the procedure. In case of emergencies, it can be done 48 hours after the procedure. Pre-certification does not guarantee the approval of benefits. Other guidelines will be applied before the amount can be paid.
What if the person does not get pre-certification? Some insurance companies penalize this with a deductible, which can be as high as $1,000. Other companies reduce the benefit by a certain percentage, say 50 percent. So keep in mind, when in doubt, pre-certify!