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HCR 220 week 3 Eligibility, Payment, and Billing Procedures CheckPoint

HCR 220 week 3 Eligibility, Payment, and Billing Procedures CheckPoint

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There are 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
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