With all of the changes in health insurance products today, eligibility and benefit determination are more important than ever. Your staff’s ability to make accurate assessments regarding eligibility and benefits is critical to reducing denials.
The following are merely a few of the many needles in the ever-growing haystack:
· New products offer restricted networks that exclude providers or place them in a higher out-of-pocket costs category;
· Consumer-driven health plans mean higher out-of-pocket costs to the patient;
· Consumers seeking individual policies or some kind of "lite" product exclude many benefits or severely limit reimbursement; and
· Employers are switching plans at an increasing rate, creating more changes to eligibility