EC & Quoting
How much is an EC over the counter with NO appointment?
A specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims
What is a deductible?
For this visit we use “Physician Visit-Office: Well-BZ” for the office visit benefit and “Screening Laboratory” for the lab benefit
What is preventative?
To qualify for the state program patients must be California residents, be 200% or below the Federal Poverty Level, be of reproductive age, and cannot have insurance coverage unless they have confidentiality concerns, their plan does not cover FP services, or they are unable to meet their deductible/share of cost
What is Family PACT?
This emergency contraceptive can be sold over the counter and is for patients with a BMI under 29 and had unprotected intercourse within the last 72 hours
What is EContraEZ?
Health care coverage where you typically select a physician to be your primary health care provider. If you choose to seek treatment from a non-network physician, you will generally be required to pay most of the cost yourself.
What is a HMO?
What are we NOW quoting for GAF Appointments Cat A - Cat D?
105-170
For this visit we use “Professional (Physician) Visit-Office” for the office visit benefit and “Diagnostic Lab” for the lab benefit
What is non-preventative?
To qualify for this federal grant program patients must be 250% or below the Federal Poverty Level and uninsured. If patients are unable to reproduce or do not live in California they can still qualify for this program.
What is the Title X program?
This emergency contraceptive must be prescribed by a clinician and is for patients whose BMI is over 30 and had unprotected intercourse within the last 5 days
What is Ella?
More flexible insurance plan, but it still operates with a list of physicians that are considered "within the network.” With this plan, you may visit an out-of-network provider and still receive some coverage for their services. If patients choose to go out-of-network, they may need to pay for services and submit an itemized receipt to their insurance provider for a partial reimbursement.
What is a PPO?
141-230
What Contracted Insurance Company Does NOT have a screening laboratory option?
(On Availity)
What is Anthem?
To qualify for this state program patients must be California residents, 213% or below the Federal Poverty Level, and cannot have insurance coverage unless their plan does not cover abortion services or the patient is unable to meet their deductible. This program covers visits to the emergency room but does not guarantee coverage for overnight stays. Coverage is valid until the last day of the following month.
What is Presumptive Eligibility?
We collect these when patients don’t want to disclose family size & income or if they would like to bill/submit a claim to their non-contracted PPO for a possible reimbursement
What are list prices?
The “deductible” of Medi-Cal that must be met monthly. Once met patients are covered at no cost. If patients are unable to meet this monthly amount, we can enroll the patient into FPACT for FP services. However, patients cannot enroll in PE and will need to pay out of pocket for AB services.
What is a share of cost?
Title X, Family PACT, and Medi-Cal are a part of this sliding fee scale
What is the Title X sliding fee scale?
For Medi-Cal Insurance when do we put AJC and JQC?
(Two Answers)
AJC - Blue Shield Promise
JQC - Anthem
What Medi-Cal needs a PA for GAC Appointments?
Ex: Medical LA Care etc.
EC can be dispensed with birth control during what visit with Kaiser Insurance
What is a Kaiser AB?
Once this maximum amount is met, certain benefits will no longer need to be collected
What is an (OOP/MOOP) out of pocket maximum?
This Core 6 lab is not covered by Family PACT
What is Hep C?
This is what we collect when patients receive medication in house instead of getting it scripted out to the pharmacy and getting covered by their commercial insurance
What are self-pay fees?
Medi-Cal with services limited to emergencies, pregnancy related services and state funded long-term care services with no SOC/spend down. AB services and PCVs are covered by this plan.
What is Medi-Cal Emergency Postpartum?