Pre-certification

Certain services may require pre-approval from your health insurance company before they can be performed. Before your visit to the Total Center or admission to the hospital for surgery, review your health plan's booklet or call your insurance company to clarify your policy benefits and requirements. Your policy may vary from another subscriber insured by the same company. It is important for you to be aware of your plan's pre-certification requirements in order to receive the full benefits allotted for services performed.

Our staff can help you obtain authorization/approval for services performed during your evaluation at the Total Joint Center. However, pre-certification is your responsibility. Prior authorization or predetermination can be initiated by staff for procedures that your insurance company may consider experimental, elective or cosmetic. This can take a considerable amount of time (three to eight weeks) and often requires medical-necessity information to be supplied to your insurance company by the physician's staff.

Before scheduling a second-opinion consultation at the Total Joint Center, you should address any second-opinion requirements with your insurance company. The insurance company can tell you if pre-certification is required.

Plans That Require Pre-certification

If your insurance plan requires pre-certification for some testing or procedures your Total Joint Center physician may order, it is your responsibility to advise registration staff of those requirements. If pre-certification is required, our staff will call your insurance company or primary care physician (PCP) for approval if necessary.

Pre-certification is not performed unless you notify our registration staff to do so. If pre-certification was required but not done, your benefits may be reduced or denied and become your responsibility to pay in full.