What does precertification entail?

Precertification is a process that involves a review by a health insurance company to determine whether a specific medical procedure or service is medically necessary, appropriate, and safe to be performed for a particular patient. This process often takes place before the service is delivered, ensuring that any requested medical treatment meets the insurer's criteria for coverage.

In scenarios where a procedure is being considered, the insurance company will assess factors such as the patient's medical condition, the necessity of the procedure, and whether there are alternative treatments that should be tried first. This helps to ensure that the patient receives appropriate care while managing costs for both the patient and the insurance provider.

While other options refer to important aspects of healthcare processes, they do not accurately describe the precertification process. For instance, medication coverage involves different prior authorization processes, while a written verification of a patient's illness and decisions made by specialists relate to other aspects of patient management and communication but do not specifically define precertification.