Pre-Authorization

Pre-Authorization and Financial Clearance Options for Scheduled Services

To ensure that patients of Valley Medical Center are able to maximize their insurance benefits as well as minimize out of pocket expenses, VMC has adopted this Financial Clearance policy. This policy can be viewed in its entirety here. Please also read our guidelines for preparing for your stay at VMC.

Some procedures may require you to obtain pre-authorization from your insurance company or to make other financial arrangements in advance.

Valley Medical Center and your physician’s office will make every effort to pre-authorize payment by your insurance company and/or assist you in finding other payment sources well in advance of your procedure, once a determination has been made to schedule your services.

For Patients with Medical Insurance: 

• Once a determination has been made to schedule you for services, Valley and your physician’s office will work together to provide required information to your insurance plan and make every effort to obtain pre-authorization
• If your insurance plan is unable to provide authorization of your scheduled procedure by noon one business day prior to service, you and your physician’s office will be contacted to request delaying services to ensure you do not incur unnecessary out of pocket medical expenses.
• While Valley and your physician’s office will work together to confirm your health benefits, if you are unsure on what will and will not be covered by your plan, we encourage you to familiarize yourself with your benefits and plan limitations (or non-covered services).

Deductible and Estimated Out of Pocket Expenses: 

• Once Valley has confirmed your health benefits, you may be contacted by a member of Valley’s Patient Access team to provide you with an estimate of the hospital financial responsibility as provided by your health plan.  
  
  
• Payment of estimated patient financial responsibility is requested prior to services. 

For Uninsured Patients:  

• Payment of estimated patient financial responsibility is required prior to services. Valley is also able to offer an uninsured discount.
  
  
• As soon as you are aware of a need for services or no less than 72 hours (or three business days) prior to the date of your scheduled procedure you will need to contact or stop by the admitting office to talk with a Financial Advocate. They will be able to provide you with an estimate for hospital charges as well as additional professional fees such as anesthesia and radiology services.
  
  
• For emergent services the Financial Advocates will help determine whether you may be eligible for Medicaid, COBRA or other payment sources. Your compliance with this screening is important to avoid unnecessary delays in services