Pre-certification

Definition - What does Pre-certification mean?

Pre-certification refers to the process through which a patient obtains authorization from their insurer to receive a particular prescription drug or health care service. It establishes that the insurance company is willing to pay for the medical services in question, but it is important to note that pre-certification does not guarantee coverage. However, without it, there is no chance of the insurer covering the procedure, treatment, or drug.

It may also be known as pre-authorization.

Insuranceopedia explains Pre-certification

The health insurance company may require the health provider to submit a pre-certification request that explains the need for the service as well as other related documentation, depending on the insurer. It is often necessary in the context of hospital admission. Certain exams, such as mammograms, do not require it, and many others, such as MRIs and CT scans, are often pre-certified. As for other services, it depends on the plan.

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