A
How do you quote benefits?
Triangle of Care or Verification of Benefits (VOB)
Benefits (Copay or Coinsurance)
Provider
Authorization
What tool will we use to quote the benefits?
DEBUT
What excel file we will use to check if procedure requires pre-authorization or not?
PAL List
What is deductible?
A deductible is the set dollar amount you pay for medical care before the insurance starts sharing costs.
What tool do we use to check if the member has met their deductible or MOOP?
Benefits > Summary
What excel file we will use to check if referral is needed?
Referral Guidance Tool
What is copayment?
Copay is a fixed amount that a member pays for a covered medical service, usually at the time of service.
What is Maximum out of Pocket?
The out-of-pocket maximum is the yearly cap on the amount you have to pay for covered healthcare services, after which your insurer pays 100% of costs.
What is coinsurance?
Coinsurance is the percentage of a medical bill you pay after you meet your deductible and the cost is shared between the member and the insurance company.
How do we check the member’s deductible and MOOP for their plan? And how do we identify services that are excluded or don’t require a deductible?
Debut > Costs and deductibles