Checkpoint Eligibility, payment, and billing procedures

Checkpoint Eligibility, payment, and billing procedures -...

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There are many different factors that determine a patient’s eligibility for benefits such as the patient’s coverage has ended due to no longer meeting the requirements of the employer to be entitled to the employer’s health insurance. This could be due to a decrease in hours, loss of job, or disability. A dependents who is eligible to be on their parents health plan becomes no longer eligible on the last day of the month they reach a certain age. Also a patient could not be eligible for benefits because the insurance premium was not paid. When an insurance plan will not cover a procedure that a patient is going to have done the patient should be made aware that their insurance will not cover the service because it is not a service that the insurance plan covers. The patient should be made aware of how much they will be responsible to pay for the procedure and that payment would need to be made before the services are performed.
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Unformatted text preview: Examples of eligibility factors would be that an employee was at one time a full time employee, but the employee had a decrease in hours that made the employee no longer eligible for the employer sponsored health insurance. The employee’s insurance cover would end at the end of the month. The employee could then receive COBRA that would allow them to continue with their health insurance, but they would be responsible for the entire premium. Another example would be that an insurance plan states that a child who is attending college is eligible to stay on their parents insurance until they reach a certain age. At the end of the month that the dependent reaches that age coverage would end. Another example that would factor in eligibility is if the insurance premium as been paid. If the premium has not been paid then insurance coverage would not be valid....
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