What is the difference between pre-certification and concurrent review?

Pre-certification is a process that occurs before the treatment is provided. It involves obtaining approval from the insurance company to ensure that a specific service or procedure is covered under the policy before the actual treatment takes place. This step is crucial as it helps determine the necessity of the procedure and that it aligns with the patient’s health insurance plan guidelines. Pre-certification helps prevent unexpected medical bills by confirming that the insurance will cover the costs associated with the proposed treatment.

In contrast, concurrent review typically takes place during the course of ongoing treatment. It involves the insurance company assessing the appropriateness and medical necessity of the care being provided as the treatment progresses. This process can lead to adjustments in coverage based on the patient's current health status and treatment outcomes.

By understanding the timing and purpose of pre-certification in relation to treatment, it is clear why this option is the correct answer.