Checkpoint: Eligibility, Payment and Billing Procedures Essay

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CheckPoint: Eligibility, Payment and Billing Procedures Vanessa Merassaint HCR/220 November 1, 2012 Pamela Kerby There are several different factors that determine a patient’s benefits eligibility. The factor I would like to bring attention to is; if premiums are required the patient must have paid on time and that they are up to date. The appropriate steps to take when insurance does not cover a planned service is discuss the situation with the patient, making sure that they understand that they are not covered by the insurance and will have to pay out of pocket for the services that are needed. In simple terms if the patient’s benefits have lapsed and or no payment has been made, when and if the patient needs medical attention they will have to pay out of pocket for those services. There could be several factors to why the patient has either no benefits or the procedure that needs to be done is not covered. Could be the payment was late, or was told the insurance was paid when in reality it was not; this happened to my brother, in the end he fought and won it was the insurance companies error. When selecting an insurance plan maybe the information was not clearly stated or simple just thinking that it couldn’t happen to you. Two examples of patient charges that would have to be out of pocket are cosmetic surgery and annual physical examinations. I understand why insurance companies would not cover cosmetic surgery, even with the simplest procedure anything could happen, it’s a liability issue. Not covering an annual physical examination is something that I do not understand; the insurance companies I have dealt with an annual physical is covered. I guess that is one for the

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