Parts of insurance
This dollar amount is what the patient pays from insurance monthly
premium
A high dose is what kind of rejection
Drug utilization rejection (DUR)
This insurance is paid by your employer
commercial insurance
6-digit number that routes insurance claims to the appropriate insurance provider
BIN Number
rejection of a non-preferred product can be resolved with
Prior authorization
This insurance is funded by federal and state government
Medicaid
this is an out-of-pocket
amount that you may need to pay
before services rendered are covered
Deductible
RTS stands for
Refill too soon
This insurance is managed by the federal government mostly for people over 65 years old.
Medicare
the insurance pays a
portion of the service, and you pay a
portion of the service. These are
usually set amounts
Co-pay
Being prescribed too much medication can result in
Day supply rejection
Which Medicare plan covers prescription drugs
Part D
the maximum amount of
money your insurance can make you
pay. Once exceeded, your insurance
should cover the rest until the
deductible resets (usually Jan 1)
Out of Pocket max
If your gender does not match your insurance, this may result in
Gender rejection
Tricare is insurance for
military veterans and family