Let’s get familiar with the term and process known as “Pre-certification” to avoid any claim related issues. While you may not need pre-certification for each and every medical service you take, it is important to understand when you should. Let’s understand what is pre-certification and when is it required for visitors and travel medical insurance?

What is Pre-Certification/Authorization: It is the process of obtaining prior authorization from the insurance company for major medical services like planned surgery, hospitalization, or other complicated expensive procedures. It is not necessary to get pre-certified for less complicated medical services like general doctor’s consultations.

When Do We Need Pre-Certification: Pre-certification is usually required for any major medical service necessary for planned hospitalization, surgery, or other complicated medical procedures. Failure to obtain pre-certification often results in a financial penalty.  Pre-Certification is not required for emergency hospitalization. However in such cases, you would need to contact the insurance company within a reasonable time frame.

Why Get Pre-Certified: Pre-certification is the most common administrative practice in the insurance industry. It allows the insurance company to:

1.    Determine whether the required service is covered in your policy or not.
2.    Evaluate if specific medical services such as hospitalization, are appropriate treatment for a patient, thus controlling healthcare costs and limit unnecessary medical procedures.
3.    Assist you in finding hospitals and doctors that can perform such procedures, and help in negotiating the rates.

It is recommended that you proactively inform the insurance company in case of any in-patient medical service or any major medical situation.