WHAT DOES PRECERTIFICATION MEAN?

Precertification means that the plan approval must be obtained before a procedure can be started. Also known as pre-authorization, a plan has the ability to impose penalties if precertification is not obtained prior to the procedure. Penalties may include denying the claim in its entirety, imposing a financial penalty or paying a reduced amount. When an employee is enrolled in a plan that has both in and out of network benefits, the in network providers are typically the ones that obtain all required authorizations for procedures. When the procedure is done out of network, the responsibility is on the employee to seek the necessary approval.