Insurance Approvals: Pre-Certification and Prior Authorizations
Alpha Men’s Clinic doctor will decide which procedures, tests and other consultations you may need. However, many health plans require pre-certification and sometimes predetermination of medical necessity prior to care being rendered. In addition, some services may not be a covered benefit for some plans. Investigating coverage requirements and limits can take up to six weeks, and some services require pre-certification staff to supply photos and medical necessity information to your insurance company.
For example, services that may require pre-certification include inpatient hospital services, observation services, invasive procedures, CT, MRI and PET scans.
Patients are responsible for knowing the pre-certification requirements of their health plans. Alpha Men’s Clinic highly recommends that you contact your insurance company to determine benefits and coverage for the Alpha Men’s Clinic location at which you plan to be seen.
- Managed care plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) may deny or reduce benefits if care is obtained outside of the established network or authorization of the plan.
- Patients’ plans that require prior authorization or pre-certification may provide only a reduced insurance payment if not previously authorized. In such cases, the patient will be financially responsible for more — possibly all — of the provided services.
- A pre-service deposit may be required for non-authorized visits.
- To avoid paying a pre-service deposit or experiencing either denial of payment or a reduction of benefits, Alpha Men’s Clinic highly recommends you contact your insurance carrier prior to services to determine plan requirements or limitations to receiving care at the Alpha Men’s Clinic site at which you will receive services.
Before scheduling a second-opinion consultation at Alpha Men’s Clinic
Address any second-opinion requirements with your insurance company. The insurance company can tell you whether it covers second opinions and whether any pre-certification requirements apply.
Please contact us to verify that Alpha Men’s Clinic has received your authorization:
In the event your insurance provider will not cover the said procedures not to worry. We offer various options for our patients to still get procedures, tests and other consultations you may need. We offer: Membership Plans, Care Credit, in house payment options. Please speak to a Treatment Counselor for more information or to BOOK APPOINTMENT
Alpha Men’s Clinic
- 956-441-2188 Office
- 956-350-8371 Fax
- 8 a.m. to 6 p.m. Central time, Tuesday through Friday