How are pre-admission certifications primarily used in health insurance?

Pre-admission certifications are primarily used in health insurance as a tool to prevent nonessential medical costs. This process involves obtaining approval from the insurer before a patient undergoes certain procedures or treatments, particularly those that may incur significant expenses. By requiring a pre-admission certification, insurance companies aim to ensure that the proposed medical services are medically necessary and appropriate for the patient's condition.

This helps control healthcare costs by identifying and potentially denying coverage for unnecessary or excessive medical services that do not meet established criteria for necessity. In this way, pre-admission certifications support more efficient resource allocation and help manage overall healthcare spending in the system.

While confirming diagnosis, determining eligibility for coverage, and expediting claim processing are important functions within health insurance, they are secondary to the primary goal of pre-admission certifications, which is to manage costs related to nonessential medical procedures.