Question:
Whats the difference between pre-determination and pre-certification?

If I have been pre-determined that this procedure is medically necessary do I still need to be pre-certified? I have cigna PPO.    — Tonya G. (posted on February 14, 2002)

February 14, 2002
fyi---i have cigna ppo and had the same question,,,both cigna and my surgeons office told me --pre certification is for the coverage of the actual hospital stay which is what the hospital wants b4 your booked for surgery so they know theyll get paid --pre determination is for coverage of the actual procedure which is what your surgeon wants so he knows hell get his $ ...this is also your approval letter i would take a min to celebrate!!! best wishes!!!!
   — TRULUV2329

February 23, 2002
I work for the company that does the precertifications for folks with Cigna PPO insurance. The other responses are correct. A predetermination for surgery is getting approval for the surgical procedure so the insurance will cover it. A precertification is getting approval for the hospital admission. Your doctor or the hospital can call to obtain the precertification, but if they have not yet done this, you can call and initiate it yourself. Always followup to make sure the authorization is completed and you can also find out how many days they have initially approved you for. I hope this is helpful.
   — [Anonymous]