Eligibility, Payment, and Billing Procedures

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General eligibility for benefits depends on a number of factors. If premiums are required, patients must have paid them on time. For government-sponsored plans where income is the criterion, like Medicaid, eligibility can change monthly. For patients with employer-sponsored health plans, employment status can be the deciding factor: • Coverage may end on the last day of the month in which the employee’s active full-time service ends, such as for disability, layoff, or termination. • The employee may no longer qualify as a member of the group. For example, some companies do not provide benefits for part-time employees. If a full-time employee changes to part-time employment, the coverage ends. • An eligible dependent’s coverage may end on the last day of the month in which the dependent status ends, such as reaching the age limit stated in the policy.

. Patients should be informed that the payer does not pay for the service and that they are responsible for the charges. Some payers require the physician to use specific forms to inform the patient about uncovered services. These financial agreement forms, which patients must sign; prove that patients have been told about their obligation to pay the bill before the services are given. I can relate to this by personal experience I have a co pay of $25.00 to see my doctor but if I am treated in the office I am billed for the remainder I was not notified from my healthcare provider before I received a bill. Patients should verify if insurance information have changed before a doctor’s visit. If the patients information has changed chances are what they need to pay up front has changed.
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