Insurance Guidelines
There is often a great deal of confusion regarding the protocols
required by managed care companies for services provided. Unlike most
traditional or indemnity insurance plans, managed care companies
require authorization for a visit to the physician's office and,
additionally, pre-certification for a procedure that you may require.
Some insurance companies provide the patient with written authorization
for his/her visit and others simply give the patient an authorization
number.
Authorization does not provide a patient with the necessary approval
to undergo a procedure; it simply means you have permission to visit a
specialist for consultation and/or an office visit. It may be necessary
to obtain authorization each and every time you visit this office. This
rule varies depending on your insurance carrier. Most of the procedures
performed in this office require pre-certification. This means at the
time of your consultation visit, you may have to return at another day
or time for the recommended procedure when proper certification is
obtained.
Authorization and pre-certification varies from company to company.
In many cases, pre-certification can be obtained by simply calling the
insurance company. Some insurance companies, however, require written
documentation for a procedure for review by a specialist, medical
director, clerk or panel of varied professional and nonprofessional
people. This can sometimes take one or two weeks. We are often asked to
submit photographs and number of treatments determined; once again the
pre-certification is delayed.
Our billing staff is experienced
and well-trained in obtaining pre-certification and authorization.
Please keep in mind that this process is time consuming. It is often
helpful for the patient to call his/her insurance company to help speed
up the process.