are There several factors that determine whether a patient is eligible for certain benefits. One factor is if a premium is required. Should there be one required; the patient must pay the premium on time. Eligibility for Medicaid can be on a month to month basis and can change often. If an individual has an employer-sponsored health insurance plan, the individual's status of employment is a deciding factor. In the case of HMO's, the provider's status as an in-network or out-of-network provider matters. Other factors in HMO's are if the patient is listed on the plan's master list of enrollment and the patient being assigned to the PCP by the date of service. The copay amount affects patient's eligibility along with if the planned service or procedure is a covered service. If a patient's insurance policy does not cover a particular service or procedure, the office will discuss the situation with the patient. Patients need to be informed about what their insurance will not cover and what services will not be covered. The patient must be informed that the uncovered services be must paid by them to settle the financial account. The patient should be informed that prenatal care and delivery is not covered by their medical insurance plan. If the patient chooses to continue with the care in this facility they must be willing to cover these charges. Service to be performed: Prenatal Care Estimated charge: $1000 Date of planned service: Feb 17, 2012 Reason for exclusion: Prenatal care is not covered under medical insurance plan I, Melissa Christ, a patient of Dr. Webb's, understand the service described above is excluded from my medical health insurance. I am responsible for payment in full of the charges for this service. Service to be performed: Delivery Estimated charge: $1800 for vaginal delivery and $3,200 for C-Section Date of planned service: Oct. 28, 2012 Reason for exclusion: Delivery is not covered under medical insurance plan. I, Melissa Christ, a patient of Dr. Webb's, understand the service described above is excluded from my medical health insurance. I am responsible for payment in full of the charges for this service.