What is the function of predetermination in insurance?

Predetermination in insurance refers to a verification of benefits through a written request. This process allows healthcare providers to ascertain in advance the extent of coverage a patient has for a certain procedure or treatment. By submitting a predetermination request, the provider seeks an estimate from the insurance company, detailing what costs will be covered before the service is rendered.

This function is crucial for both the provider and the patient, as it helps to avoid unexpected medical bills and provides clarity on the insurance carrier's policies regarding coverage for specific treatments or procedures. Understanding what is covered enables patients to make informed decisions about their care and helps providers plan for the financial aspects of treatment delivery.

While the other options mention potential aspects that could relate to insurance processes, they do not accurately describe the purpose of predetermination. For instance, predetermination does not guarantee coverage after a procedure, nor does it serve as a request for hearings or a guide for selecting doctors.