Health Insurance Claim Articles

Health Insurance Claim Denied, Pre-Approved Medical Procedure

By Jeffrey L. Greyber, Esq.

Pre-approval for a medical procedure is an imperative precaution when your health insurance policy is concerned. Pre-approval or pre-certification, is an authorization that can be required by your health insurance company to ensure that said medical procedure is necessary and ultimately appropriate for your condition. Always remember that every insurance policy differs, so it is crucial to know exactly what is covered in yours.

I have witnessed numerous instances in which the policyholder has indeed been pre-approved for a medical procedure, prior to surgery of course, via the insurance company, and then after the fact of surgery, the insurance company is withdrawing coverage to the policyholder. Or in some other situations I have come across, policyholders are considered pre-approved for their medical procedure, and then before said procedure can take place, the insurance company revokes coverage.

These pre-approvals are absolutely beneficial and many times required by your insurance company, but it is important to keep in mind that they are in no way definitive on coverage in the end. There is in fact, a separate board of approval that must assess your medical coverage after the occurrence of proposed medical procedure. This fine print located within your insurance policy catches a great deal of policyholders off guard.

While it is not the ultimate say, it is still absolutely recommended that policyholders obtain pre-approval for indicated medical procedures. Also, whether it your physician or yourself, I advocate that the pre-approval be physically documented.

Health Insurance Claim Articles