Question

11.4

1.   How does the medical billing specialist handle billing if the member also has other insurance ?

2.   What purpose would supplemental insurance policies serve for Tricare beneficiaries ?

18.   What are the costs for Tricare extra ?

Answer 1

Ans) 1) Once patient information has been recorded or updated, the physician’s office establishes who will be paying for the medical services that will be provided during the appointment.

Insurance coverage differs, often dramatically, between insurance providers and individual plans, so the first step is to familiarize yourself with the patient’s insurance coverage. Using the insurance information provided by the patient, including their insurance policy number, the office must confirm which services are covered under the patient’s current insurance policy and what medical conditions (diagnoses) the insurance provider requires in order to justify payment for those services.

For instance, a policy may cover certain types of blood work, but only if a specific diagnosis (such as hypercholesterolemia) is given by the physician. It is also important to confirm which services are explicitly not covered under the patient’s insurance policy. Knowing this information is crucial to ensuring reimbursement. For instance, if a patient is scheduled for an appointment that may require services not covered by their insurance policy, the patient should be informed that they will have to pay out of pocket before these services are rendered.

2) Most TRICARE health plans meet the requirements for minimum essential coverage under the Affordable Care Act. TRICARE is managed by the Defense Health Agency under leadership of the Assistant Secretary of Defense (Health Affairs).

18) Most TRICARE health plans meet the requirements for minimum essential coverage under the Affordable Care Act. TRICARE is managed by the Defense Health Agency under leadership of the Assistant Secretary of Defense (Health Affairs).