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Insurance Verification

Horizontales
Insurance Company name
The employer group pays claims and the payor processes the claims only
Typically seen in self-funded plans
A clause that states any condition in which treatment was received prior to the effective date will not be covered for the period of eligibility
Flat Fee
The amount of money a patient will have to pay prior to the insurance company providing coverage
HMO, PPO. EPO, POS
Maximum amount of benefits that will be paid on behalf of patient in one year
Verticales
Consolidate Omnibus Budget Reconciliation Act
Number identifies a policy covering a particular patient, some have letter prefixes
Percentage of cost that the patient and the payer pay for medical sevices
The max dollars a patient will be responsible for paying out of their pocket. Also known as a stop loss
Private commercial, Medicare, Medicaid, Tricare
Once this is reach, the patient has no more coverage throughout that policy