What Is Pre-Authorisation?

Pre-authorisation (also called prior authorisation or pre-approval) is the formal confirmation from your health insurer that they will fund your treatment. Without it, your insurer may decline to pay your claim even if your policy covers hip or knee surgery in principle.

The process is straightforward but must be completed before your treatment begins. Most insurers require a separate authorisation for each stage: the initial outpatient consultation, any imaging such as MRI or X-ray, and then the surgical procedure itself. Each generates its own authorisation number, which must be quoted when booking and invoicing.

Authorise before you book

Pre-authorisation must be obtained before your consultation and again before any surgery is scheduled. Retrospective authorisation (obtained after treatment has already taken place) is refused by most insurers. Starting the process before your first appointment is always the right approach.

The Pre-Authorisation Process

The steps below apply to most major UK health insurers. The exact wording and portal names differ by insurer, but the underlying sequence is consistent. Wendy Richards, Mr Hussain's secretary, handles the paperwork at the practice end once a treatment plan has been agreed.

  1. Obtain a GP referral

    Most insurers require a written referral letter from your GP before they will authorise a specialist consultation. The letter should name Mr Shakir Hussain as the intended consultant and state the clinical reason, such as hip pain, knee pain, or suspected osteoarthritis. Some insurers also accept a referral from another specialist. Ask your GP to send this to you as well as to the practice, so you can quote the details when you call your insurer.

  2. Contact your insurer to authorise the consultation

    Call your insurer's pre-authorisation or claims line, or log in to their online member portal, and request authorisation for an outpatient consultation with Mr Hussain. You will need your membership number, your GP referral details, and Mr Hussain's name and GMC number (6135851). The insurer-specific contact details are listed further down this page. Most insurers will issue a consultation authorisation number on the same call or within a few hours online.

  3. Attend your consultation with Mr Hussain

    At your consultation, Mr Hussain will review your clinical history and any existing imaging, examine you, and discuss your options. If you need further investigations such as an MRI scan or weight-bearing X-rays, the practice will advise you to obtain authorisation for these separately from your insurer before they are arranged. If surgery is recommended, the practice will prepare a treatment plan that includes the hospital name, the procedure description, and the relevant CCSD procedure codes for your insurer.

  4. Obtain surgical authorisation

    Once you have decided to proceed with surgery, you or the practice will contact your insurer to obtain a separate surgical authorisation number. This covers the surgeon's fee, the anaesthetist, the implant, and the hospital stay. Wendy Richards can liaise with your insurer directly at this stage if you prefer. The surgical authorisation number must be confirmed before your operation date is finalised. Allow at least five to ten working days for this step, as some insurers request additional clinical information.

  5. Quote your authorisation number when booking

    Pass the authorisation number to the practice when confirming your surgery date. The practice will also record your insurer's name and membership number so that all invoices are submitted correctly on your behalf. If your insurer has co-payment or excess conditions, the practice will advise you of any patient-payable element before surgery.

What to have ready when you call your insurer
  • Your insurance membership number (on your policy card or insurer app)
  • Your GP referral details (the GP's name, practice, and date of referral)
  • Mr Hussain's name and GMC number: Mr Shakir Hussain, GMC 6135851
  • The hospital name where you plan to be treated (Royal Orthopaedic Hospital, Priory Hospital Edgbaston, or Harborne Hospital)
  • The procedure description and CCSD code (see table below; the practice will confirm exact codes)

CCSD Procedure Codes

Your insurer will ask for the CCSD (Clinical Coding and Schedule Development) code for the planned procedure. These are 5-character codes (a letter followed by four digits) that identify the exact surgical operation. The table below lists the codes applicable to Mr Hussain's practice. Revision surgery uses several codes depending on which components are being replaced and the complexity involved; Wendy Richards will confirm the correct code when liaising with your insurer.

Procedure CCSD Code Description
Hip Resurfacing W3715 Resurfacing arthroplasty of hip joint
Primary Total Hip Replacement W3712 Primary total prosthetic replacement of hip joint (cemented, uncemented or hybrid)
Complex Primary Total Hip Replacement W3713 Complex primary total prosthetic replacement of hip joint (used where additional reconstruction, bone grafting, custom implants, or technical complexity is involved)
Revision Hip Replacement W3732, W3733, W3734, W3742, W3743 W3732: revision without adjunctive procedures; W3733: revision with bone graft or reconstruction rings; W3734: second or further revision; W3742 and W3743: conversion to prosthetic replacement of hip joint (cemented or uncemented)
Total Knee Replacement W4210 Total prosthetic replacement of knee joint, with or without cement, with or without patella
Complex Primary Total Knee Replacement W4200 Complex primary total prosthetic replacement of knee joint (used where additional reconstruction, augments, stems, constrained implants, or technical complexity is involved)
Partial (Unicompartmental) Knee Replacement W4214 Unicompartmental prosthetic replacement of knee joint
Patellofemoral Replacement W0632 Prosthetic patellofemoral replacement (sole procedure)
Revision Knee Replacement W4230, W4240, W4242 W4230: revision of one component of total prosthetic replacement of knee joint; W4240: revision of total prosthetic replacement of knee joint, all components; W4242: conversion to total prosthetic replacement of knee joint

Common Reasons for Delay

Most pre-authorisations are issued promptly, but delays do occur. Understanding the most common causes can help you avoid them.

  • Missing GP referral: calling your insurer without a referral in place is the single most common cause of delay. Have the referral before you call.
  • Policy exclusions or waiting periods: some policies exclude pre-existing conditions or impose a waiting period after the policy start date. Check your policy documents carefully before your consultation, as the practice cannot verify your policy terms on your behalf.
  • Authorisation requested retrospectively: authorisation obtained after treatment has already taken place will almost always be declined. Authorise each stage before it happens.
  • Wrong procedure code submitted: if the code on the authorisation request does not match the code on the invoice, the claim may be queried or declined. Wendy Richards ensures the codes align when liaising with insurers on your behalf.
  • Corporate policy routed incorrectly: if your cover is through an employer scheme, there may be a dedicated pre-authorisation number separate from the standard member line. Check your policy documentation or HR department for the correct route.

"Once a treatment plan is agreed, Wendy can take over the insurer paperwork entirely if that is easier for you. Many patients find it more straightforward to let the practice manage the back-and-forth while they focus on getting ready for surgery."

Mr Shakir Hussain, Consultant Orthopaedic Surgeon

What Wendy Richards Handles

Wendy Richards is Mr Hussain's dedicated secretary and handles all insurer liaison on behalf of the practice. Once a treatment plan is agreed and you have given the practice your insurer details and membership number, Wendy can:

  • Submit the surgical pre-authorisation request directly to your insurer
  • Provide the insurer with procedure codes, consultant details, and hospital information
  • Follow up if an authorisation is delayed or if the insurer requests additional clinical information from Mr Hussain
  • Liaise with the hospital's billing team to ensure all elements of the surgical episode are correctly authorised
  • Advise you if there is a patient-payable excess or co-payment applicable under your policy

To contact Wendy directly, call 07399 114575 or email shussainorthopaedics@gmail.com. For initial enquiries about the pre-authorisation process before your first consultation, you are welcome to contact the practice in advance.

Self-Pay Patients

If you do not have private health insurance, or if your insurer does not cover the procedure you need, self-pay is straightforward at Mr Hussain's practice. Fixed all-inclusive packages are available for most hip and knee procedures, covering the surgeon's fee, anaesthetist, hospital stay, implant, and standard follow-up appointments. For current self-pay costs, please see the Fees and Insurance page, which also lists all insurers recognised by the practice.