What does precertification refer to?

Precertification specifically refers to the process of obtaining prior approval from an insurance company before a patient undergoes certain medical procedures, tests, or treatments. This process is crucial as it helps ensure that the procedures are medically necessary and covered under the patient’s insurance policy. Insurance companies often require precertification for more expensive or specialized treatments to manage costs and validate the necessity of the care being provided.

This requirement serves as a safeguard for both the patient and the insurer, as it allows for checks on the appropriateness of the care being sought. By obtaining precertification, healthcare providers can also help ensure that patients are not faced with unexpected out-of-pocket costs due to lack of insurance coverage for certain procedures.

The other choices relate to different aspects of medical treatment and insurance but do not encapsulate the specific definition of precertification accurately. For instance, while approval from a patient's PCP or provider confirms the need for treatment, it does not involve the direct authorization process from the insurance company that precertification entails.