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American Academy of Pediatrics. Committee on Hospital Care. Precertification process
Pediatrics
|August 2, 2000
Insights
Health insurance precertification, a cost-control measure, is often unnecessary. This paper suggests guidelines for its use to ensure children receive optimal medical care when precertification is unavoidable.
Area of Science:
- Health services research
- Healthcare policy
Background:
- Precertification is a common practice by health insurers to manage healthcare expenditures.
- The necessity and cost-effectiveness of precertification are debated within the medical community.
Purpose of the Study:
- To propose guidelines for the implementation of precertification processes.
- To balance cost control with ensuring optimal patient access to care, particularly for pediatric populations.
Main Methods:
- This statement outlines suggested procedures for precertification.
- The focus is on practical recommendations for healthcare providers and insurers.
Main Results:
- The proposed guidelines aim to streamline the precertification process.
- Implementation of these procedures can potentially reduce administrative burdens.
Conclusions:
- Precertification, while potentially burdensome, can be managed with effective guidelines.
- The ultimate goal is to facilitate necessary medical care for children while acknowledging the persistence of precertification policies.
Abstract:
Precertification is a process still used by health insurance companies to control health care costs. Although we believe precertification is unnecessary and not cost-effective, in those instances where precertification is still being utilized, we suggest that the following procedures be adopted. This statement suggests guidelines that should help achieve this goal while allowing optimal access to care for children.