Payment_and_Billing_Process

A number of factors determine whether a patient is eligible for certain benefits. One factor is checking to see if a premium is required. Should a premium be required, the patient must pay them on time. Eligibility for Medicaid is able to change on a monthly basis. If a person has an employer-sponsored health plan, the person’s status of employment is a deciding factor. In HMOs, the provider’s status as an in-network or out-of-network provider matters, as does the patient’s being listed on the plans master list of enrollment and the patient’s assignation to the PCP by the date of service. The amount of the co-pay affects patient’s eligibility, and if the planned service or procedure is a covered service as well. If a patient’s insurance policy does not cover a particular service or procedure, the office will discuss the situation with the patient. Patient’s need to be informed that their insurance provider will not cover the service or procedure and therefore that they will have to settle out-of-pocket themselves. The patient should be informed that the prenatal care and delivery is not covered by their insurance provider. If they choose to continue with care in the facility they must be willing to cover these charges. Here are some examples: Services to be preformed: _Prenatal Care__ Estimated Charges: __$1,500.00____ Date of Planned Services: __1/6/2010__ Reason for exclusion: __Prenatal care is not covered under Patients insurance provider_ I, _Patients Name__, a patient of _Dr. Drew_, understand the service described above is excluded from my health insurance. I am responsible for payment in full of the charges for this service. Example 2, Service to be preformed: _Delivery_ Estimated Charges: _$3,000.00_ Date of Planned Service: __1/6/2010_ Reason for exclusion: _Delivery is not covered under patient’s insurance___ I, __Patient’s Name, a patient of, _Dr. Drew__, understand that the service described above is excluded from my health insurance. I am responsible for payment in full of the charges for this service.