Certain services may require pre-approval from your insurance company before being performed. Prior to your visit, review your health care plan booklet or call your insurance company to clarify your specific policy benefits and requirements. Your policy may vary from another subscriber insured by the same company. It is important for you to be aware of your plan’s specific pre-certification requirements in order to receive full benefits allowable for services performed.

Our pre-certification staff can help you obtain authorization / approval for services to be performed. We encourage you to also contact your insurance company before having any procedure performed. If the proposed service(s) is not a covered benefit, our staff will be happy to work out a payment plan for you. The fees are ultimately your responsibility.

Maternity care will be pre-certified once your pregnancy is confirmed. Our billing office will contact your insurance company to confirm your benefits for the physicians’ services. We do not confirm or pre-cert hospital benefits. Our benefits coordinator will discuss your benefits with you prior to your appointment.

Prior authorization or predetermination can be initiated by our pre-cert staff for procedures that may be considered experimental or cosmetic by your insurance company. This can take a considerable length of time as well as medical necessity information to be provided to your insurance company by Heartland.

Before scheduling a second opinion consultation with one of our physicians, you should address second opinion requirements with your insurance company. Your insurance can tell you what the necessary steps are in order to obtain a second opinion.

Pre-certification or pre-approval may also be required for certain tests or procedures that may be ordered by your Heartland provider. If pre-cert is required, the pre-certification staff will contact your insurance company or primary care physician for approval.