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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.