What is the process of discovering whether a test or treatment is covered under a patient's insurance contract?

The process referred to in the question pertains to ensuring that a specific test or treatment is covered by a patient's insurance plan. Precertification involves obtaining authorization from the insurance provider before a procedure or service is performed, which confirms whether the treatment falls under the coverage terms of the patient's insurance policy. This step is crucial in preventing unexpected medical expenses for the patient and ensures that the provider will be reimbursed for the services rendered.

Preauthorization is often used interchangeably with precertification, but precertification specifically denotes the prior approval that is required before the service is delivered, focusing on the insurance coverage aspect. Preapproval typically relates to obtaining approval from a provider’s insurance network, and co-payment determination involves understanding the patient’s financial responsibilities regarding the treatment, rather than establishing coverage. Therefore, the most accurate term for the process of discovering coverage for a specific test or treatment is the precertification process.