Visitor Insurance provides coverage for medical emergencies that may occur during travel. These plans provide lots of benefits, such as in-patient and out-patient treatment, surgery, hospitalization, urgent care, etc. Certain medical services when availed by the visitor insurance requires Precertification by the visitor insurance company.

What is Precertification

Each proposed hospital admission, in-patient or out-patient surgery, and other procedures as noted in the Certificate of Insurance must be Precertified for medical necessity, which means the insured person or their attending physician must communicate with the insured’s insurance company representative at the number listed on the insurance company identification card prior to admission to a hospital or performance of a surgery. The Precertification may pertain to a hospitalizations, surgeries, emergency evacuations, emergency reunions, trip interruptions, Repatriation of Remains, computerized tomography (CAT scan), Magnetic Resonance Imaging (MRI), etc.

The process of Precertification

Not all medical services require Precertification. Major services like hospitalization, surgeries, expensive diagnostic tests like CT scans, MRIs etc. require the visitor to inform the visitor insurance company prior to availing them. In case of life-threatening medical emergency, the visitor can inform the insurance company within 48 hours of hospital admission, or soon as possible. Attending doctor or medical provider can also inform the insurance company on visitor’s behalf in case the visitor is not in a condition for the same. The insurance company’s contact details are found on the insurance ID card. Some insurance companies allow to do Precertification online. It is advisable to understand the process of Precertification before the insurance policy comes into effect. It is also recommended to inform the hospital or the relevant medical providers about your Precertification and your communication with the insurance company.

Why is Precertification needed?

  • If the insured do not inform the insurance company for any medical service that needs Precertification, the payment for qualifying claims and medical expenses will be reduced by 50%.
  • Unnecessary procedures, tests, prescription drugs can be avoided when their medical necessity is assessed. Hence the visitor is saved from the high healthcare unnecessary expenses.

Facts about Precertification

  • Precertification do not guarantee the payment of claims. The claim submission and assessment process will be performed as per the rules and conditions in the particular insurance plan to determine the payment of the claim.
  • All medical expenses eligible for reimbursement must be medically necessary and will be paid or reimbursed at usual, reasonable, and customary rates. The Certificate of Insurance should be referred for full details of the Precertification requirements.
  • If the visitor is unaware of the precertification process, the insurance company will not be able to waive this requirement. Policy documents hence should be read thoroughly for benefits, exclusions and other details. When in doubt, do not hesitate to ask questions to your insurance agents.

Precertification though do not guarantee payment of benefits but it is mandatory for certain medical procedures. If you have any question regarding Precertification or how and when to do it, contact MCIS today. Our experienced agents will take you through step by step process of Precertification.

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