841226853 JAMES STRAUSS
933102822 BEVERLY KILBY
957877226JASON CHANG
906328799 SADIA GHAZALI
965447941 MEGAN OWENS
100
Eye Examinations?
What is Not Covered
100
The HRA balance is?
What is there is no HRA account.
100
What type of ded does this plan follow, individual or family? INN?
What is For single coverage, the Annual Deductible is $3,000 per Covered Person per policy year.
100
DOS 9/9/16 Suburban Community Hospital, when was the check for $2,168.46 issued to the provider?
What is 9/29/16
100
What benefit applies to prenatal care?
What is No Copayment applies to Physician office visits for prenatal care after the first visit in which an $25 applies. Prenatal care and postnatal visit performed by an in-network provider covered at 100% of eligible expenses
200
FSA Vendor?
What is ● Administered by: WageWorks ● Call 1-877-924-3967
200
Can Beverly receive a shingles shot INN?
What is Preventive care services Preventive Care:- Immunizations, Well Child & Well Adult - Including PSA, Pap, Mammogram 100% of eligible expenses
200
What is the Total patient responsibility for DOS 6/1/16 Sunrise medical labs?
What is $72.48
200
How many days does she have to add her newborn baby to the account?
What is Newborn Process The child is automatically covered for a 31-day period under the employees SSN as "Baby Boy or Baby Girl." Claims incurred/submitted during this period of time will be paid. Any claims received after the 31-day period, (for DOS after the 31 days post-birth), will be denied unless child has already been added as a dependent.
200
What is the claim filing limit?
What is You must submit a request for payment of Benefits within 12 months after the date of service. If you don't provide this information to us within 12 months of the date of service, Benefits for that health service will be denied or reduced, in our or the Claims Administrator’s discretion. This time limit does not apply if you are legally incapacitated. If your claim relates to an Inpatient Stay, the date of service is the date your Inpatient Stay ends. With respect to this claim filing limit, “you” refers to the member.
300
Annual Deductible INN and ONN?
What is $650 per Covered Person per calendar year, not to exceed $1,950 for all Covered Persons in a family. $950 per Covered Person per calendar year, not to exceed $2,950 for all Covered Persons in a family.
300
Is doctor Rosalia Aiello INN for Beverly at the 5800 Santa Rosa rd Ste 123 Camarillo CA 93012. And what is the specialty?
What is Yes, Audiology/Audiologist
300
Does the ded apply to the OOP? INN?
What is Do deductibles apply to out-of-pocket? Yes
300
True or False The Nuvaring is free for Sadia under the HCR law
What is False NUVARING etonogestrel-ethinyl estradiol va ring 0.120-0.015 mg/24hr NA Ring Tier 2
300
What is the funding arrangement?
What is ASO
400
Newborn Process
What is The child is automatically covered for a 4-day period under the employees SSN as "Baby Boy or Baby Girl." Claims incurred/submitted during this period of time will be paid. Any claims received after the 4-day period, (for DOS after the 4 days post-birth), may be denied unless child has already been added as a dependent.
400
What are the criteria the person must meet for Lap Band Surgery?
What is Lap Band surgery is covered provided the following conditions are met: · Person is 18 years old or older. · Body mass index (BMI) of 40 or greater for 2 years. · BMI of 35 to 39 for at least 2 years with evidence of co-morbid conditions attributable to obesity: sleep apnea, Type 2 Diabetes, asthma, hypertension, CHD, osteoarthritis, gall bladder disease, several types of cancers, amongst other conditions. · Evidence of nutritional counseling by a physician for at least 6 months within 2 years of surgery date. · Sleeve gastrectomy procedures covered. Precertification required
400
The email address on file for Jason is?
What is JACHANG116@GMAIL.COM
400
What is the description of the HCR Tobacco Cessation program?
What is HCR Tobacco Cessation medications, both OTC and Prescription formulations, are available at zero dollar cost share to the member. The Formulary Lookup Tool Drug Details Clinical Programs section will indicate if a medication is part of this program. The program will be listed as HealthCare Reform Preventive Medication. Age and Prior Authorization restrictions may apply and will be noted. Two 90-days treatment cycles will be covered per year.
400
Which rule of NOBLX applies for this plan?
What is Non-Network Office Based Lab and Diagnostic Processing New Processing does not apply. Explanation: Old NOBLX logic applies Benefits for lab and diagnostic services will be based on the network status of the ordering physician.
500
Do require CT Scans, PET Scans, Nuclear Medicine and MRI’s.
What is Note: Radiology notification required for outpatient MRI/MRA Scans, CT Scans, PET Scans and Nuclear Medicine Studies for services rendered by a Network Provider. The Network Provider will be sanctioned for non-notification. Network Providers Only - please select the "Radiology/ Notification prompt when confirming benefits for these services.
500
What is the timeframe for prosthetic devices?
What is The prosthetic device must be ordered or provided by, or under the direction of a Physician. We provide Benefits for a single purchase, including repairs, of a type of prosthetic device. Benefits are provided for the replacement of each type of prosthetic device every 5 calendar years.
500
If Jason wanted a SDM report emailed to him, what are the steps?
What is Emailing SDM report. Create report in SDM Tool. Click File, Send, page by email. Document ORS in ISET that you are sending SDM report. Priority is Urgent. F/U is open and make a  R code commitment. Email shareddecisionmaking@uhc.com with the mbr’s name, mbr ID, email, and the ORS# you created. Attach report to the email.
500
What is the set number for the plan?
What is 058
500
What are the DX and CPT codes for DOS 9/14/16, and their descriptions?
What is DX codes Z30.40(ICD10) Encounter for surveillance of contraceptives, unspecified Last Update - 10/01/2016 Z39.2(ICD10) Encounter for routine postpartum follow-up Last Update - 10/01/2016 Z392 CPT 85018 Blood count; hemoglobin (Hgb) Last Update - 08/18/2016 81002 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy Last Update - 08/18/2016
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