It is confusing today not knowing what is covered and how much, thus many doctors offices are checking online to find out what they can to see what portions may or may not be covered by insurance carriers. It certainly is not getting any easier to figure out the complicated algorithms and formulas on some of this today, finding out if the co-pay has been met, might be the easiest portion of the process, but beyond that portion it really gets very confusing for both patients and physicians today.
In addition, eligibility for Medicare can be checked as well for 25 cents per investigation. BD
A growing number of physician practices are using software programs, some developed by health insurance companies, that can immediately access a patient's insurance information and let the patient and the medical practice know precise co-pay rates, whether a deductible has been paid up and the exact or estimated dollar amount the insurer will pay once the doctor's office submits the bill. Armed with this information, often referred to as "real time claims adjudication," office managers can, and sometimes do, ask patients to pay those costs at the time of service.
Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution
Health insurer accused of overcharging millions – United Health Care/Oxford Insurance 50 Million Fine