Eligibility, Payment, and Billing Procedures Essay

September 16, 2017 General Studies

Describe a factor that determines patient benefits eligibility. Many factors determine a patient’s eligibility for benefits. Employment position is one factor that may find whether or non the patient still has benefits. If an employee no longer has a occupation they are by jurisprudence to be offered what is known as COBRA by their employer for up to one twelvemonth of expiration or a new occupation whichever comes foremost. What are the appropriate stairss to take when insurance does non cover a planned service? If a planned service was non covered by the insurance there are appropriate stairss that the doctor’s office should take. First they need to do the patient aware of the state of affairs and discourse further if they still want the process done or if they are capable of doing the payments to cover the process. After speaking with the patient the physician needs to hold the patient mark fiscal understanding signifiers to do certain that they was informed of the state of affairs and the cogent evidence the physician needs so the patients does non state they was non informed about the state of affairs.

Relate these stairss to the eligibility factor you identified and supply two illustrations of patient charges with matching charging minutess. The patient should be informed of the recommendations of preventative attention every bit good as immunisations. They must besides be informed that they insurance will non cover these disbursals and if performed it is finally the patients duty to cover these charges before the process is completed. When a patient chooses to hold dental work done and so braces put on. The coverage may be foremost denied because it is considered decorative. However. there are appeal signifiers that you can make full out and state your side of the narrative. Example: Poor dentitions and crowding of dentitions can take to bosom disease. This is what you can set in the appeal signifier along with the dentist’s information. The entreaty may be denied or approved. If denied so you can either take non to hold the process done or to do a payment program.

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