No pre-certification required?

I have spent SO many hours on this, multiple phone calls with doctor, insurance company, and billing. Nobody can give me a straight answer, and I am going in circles. I have a document that says “no pre cert required” but my insurance company, Aetna, says that doesn’t necessarily mean it will be covered. They won’t be able to tell me if its covered until the procedure is actually done, which makes NO sense to me. Is there anything else or anyone else I can contact for answers?

My doctor recommended a hip replacement for me due to severe arthritis in my right hip. I am 45f with congenital hip dysplasia that I didn’t know I had until my 40s. The scheduler pushed the pre-certification to the insurance company and their response is “no pre-certification required.” My employer company apparently doesn’t “opt in” for the pre-certification process, whatever that means.

So there are 2 ways to interpret that, but nobody can give me a straight answer that this is “approved.” I am worried they are going to come back after the surgery and deny the claim. So now I am afraid to schedule a medically necessary surgery. I have tried the cortisone injection earlier this year (didn’t really help much), but haven’t done physical therapy in a few years since it didn’t really help the first time around. My doctor doesn’t recommend that route either since the condition has gotten to be severe and is basically “bone on bone.”

Any input on this? Wondering if anyone else has gone through this process.