Eligibility, Payment, and Billing Procedures

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University of Phoenix

HCR/220
Eligibility, Payment, and Billing Procedures
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BreAwna Ingram
June 7, 2012
Ms. Linda

Eligibility, Payment, and Billing Procedures
There are actually a few factors that determine a patient’s benefits eligibility, and some of these factors include whether or not coverage ends on the last day of the month where the particular employee’s active full-time service is over, and this employee may no longer qualify for insurance benefits. For example if there was a part time employee that does not receive any benefits at their job, the employee may lose benefits by losing hours. If the insurance covers eligible dependent, the coverage may end on the last day of the month where as the dependent status will also end, or fulfilling the life of the contract with the company regarding the age limit stated in the policy. If an employee works for a company full and receives any benefits, and they drop down to part time for any reason they may lose their benefits. Procedures for non coverage

The procedure to follow when the patient is not covered for a planned service according to the insured patient’s policy is to discuss this situation with the patient. A patient is to be informed that the payer does not pay for the service and that they are fully responsible for any of the charges accrued. Some plans do not cover preventative services such as yearly physical exams. Some payers require that a physician use specific forms to inform the patient about the uncovered services. These are financial agreement forms, are a required part of the service and a patient must sign it to prove that they have been told about their responsibility to pay the bill before any services are rendered. If a person with full-time benefits has preventative care with no co-pay, then drops down to part-time and less benefits, their policy could change and they could no longer have preventative services covered. Another example could be if...
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