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Importance of Pre Certification in Medical Insurance

The Healthcare industries in most of the countries are under insurance cover.

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The Healthcare industries in most of the countries are under insurance cover. The patients under the insurance coverage of the insurance companies visit the general practitioners or the health service providers whenever they are unwell. The patients do not directly pay to the health service providers as they enjoy the benefits of cashless treatment. The insurance companies pay the health service providers after verifying the claims.

The importance of the medical billing and Management services are immense as they prepare the bills and hand them over to the insurance companies. The bills are required to be perfect and authentic so that the claims can be processed quickly. The three parties which are involved in the process depend on the medical billing and Management Service organizations who prepare the bill for each patient visiting the general practitioners or the health service providers.

Pre certification in medical insurance

The health service providers send a notification to the insurance companies that a patient requires non-urgent optional services. This type of notification is called precertification. Actually, precertification for medical services is a request for insurance coverage. The insurance companies decide whether a patient’s insurance plan covers the requested procedure or not. The pre-certification totally depends on the decision of the insurance companies where as the pre-authorization depends on reviewing the medical documents of the patient. The insurance companies take the decision on the pre certification by evaluating the cost factors and urgency and duration of the treatment.

Advantages of pre certification

The pre-certification is approved by the insurance companies if they are cost-effective and hence the patient can enjoy the benefit of additional Medical services. The pre-certification requirements are also helpful to stop the careless use of Pain killers and help people to refrain from opioid addiction.

Disadvantages of Pre-certification

Preauthorization can be described as a Process which is directed to give the best possible treatment to the patients by avoiding the unnecessary Medical Services. But the scenario is not that simplified as the health service providers have a different opinion. According to the health service provided it is a procedure on behalf of the insurance companies to make the expensive medical care more difficult. pre certification in medical billing increases the burden of the patients and The medical care services become expensive for the patients and health insurance companies can be benefited by the expensive medical care services which are not that necessary for the patients,

The general physicians or the health service providers are not provided with the reasons accepting or rejecting the medical treatment to the patients. it is a General trend on behalf of the insurance companies that expensive drugs are simply denied in the pre certification. The insurance companies encourage the physician by offering them the bonus and other facilities if they do not recommend expensive drugs to the patients in the initial phase. The physicians feel more restricted to offer proper medical facilities to the patients and as a result, the patient outcome has also so reduced due to the complications related to pre certification.

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