Travel Insurance

Travel Insurance Pre-certification: What Is It & When You Need It

Travel Insurance Pre-certification: What Is It & When You Need It

When it comes to using your travel insurance policy for medical care, you may be required to get pre-certification for your service or treatment. While you may not need pre-certification for each and every medical service, it is important to understand when you may need to get this prior authorization.

Let’s understand what pre-certification is and when it’s required for visitors insurance and travel medical insurance.

What Is Pre-certification for Insurance?

Insurance pre-certification, also referred to as pre-authorization or prior authorization, is the process of receiving approval from a travel insurance company for major medical services such as surgery, hospitalization, or other complicated expensive procedures for unexpected injuries or illness that occur during one’s travels.

In the event that the healthcare provider or physician requires pre-certification, it will be necessary to obtain prior authorization from the travel medical insurance company to ensure that the patient qualifies for coverage of that particular service.

It is typically not necessary to get pre-certified for less complicated medical services such as general doctor’s consultations.

When Do You Need Pre-certification?

Pre-certification is usually required for any major medical service necessary for planned hospitalization, surgery, or other complicated medical procedures.

Pre-certification is not required for emergency hospitalization, however, in such cases, you would need to contact the travel insurance company within a reasonable time frame to alert them of your emergency hospitalization.

Is Pre-certification for Insurance Required?

Pre-certification for travel insurance is often required for any large medical events. Be aware that failure to obtain pre-certification under certain circumstances can result in financial penalty or your claim may be denied. 

A covered treatment that isn’t pre-certified may result in a 50% reduction in benefits or more.

Why Is Pre-certification Important?

Pre-certification is the most common administrative practice in the insurance industry. It allows the insurance company to:

  • Determine whether the required service is covered in your policy or not.
  • Evaluate if specific medical services such as hospitalization, are appropriate treatment for a patient – thus controlling healthcare costs and limiting unnecessary medical procedures.
  • Assist you in finding hospitals and doctors that can perform such procedures, and help in negotiating the rates.

Each travel insurance company will have its own list of treatments or services that require pre-certification. Refer to your policy documentation to see which services need prior authorization to avoid frustrations during the claims process.

How to Do Insurance Prior Authorization

In order to get prior authorization with a travel insurance company for a service, either the patient or the physician must contact the travel insurance company to inform them of the service. A phone call to the insurance company will work.

A policyholder can call the number of the travel insurance company listed on their travel insurance ID card. It is important to call at least 48 hours before the procedure takes place or as soon as possible if you are involved in a medical emergency.

How Does Pre-certification Affect the Claims Process?

One thing that is important to remember about prior authorization for a medical procedure is that it does not guarantee benefits. This means that even if you get pre-certification for a medical service, your claim can still be denied.

You will still file your claim and provide all supporting documentation as necessary for your claim. Your claim will be approved or denied based on the travel insurance companies investigation of your treatment and medical records to determine whether or not the reason for your visit was a covered reason under the plan.

It is recommended that you proactively inform the insurance company in case of any in-patient medical service or any major medical situation. Pre-certification gives you peace of mind before you undergo any major surgery or expensive medical treatments and ensures that you don’t risk a financial penalty in the form of less benefits or a denied claim.

If you have any questions regarding pre-certification or need help selecting the right coverage amount, contact our Customer Success Team.