My name is Joshua Divinagracia , 29 years old and currently residing in Tarlac Philippines.
I've been working as an Insurance verification and verification of benefits for 4 years both Dental and Mental health practices. ( Remote )
I have a great Knowledge and understanding in Insurance terms, Policy and how it works.
The 6 importance of checking for Eligibility are :
- Effective date of the
plan
- Check if the provider is In network or Out of network with the plan
- Covered services
- Coordination of benefits
- Verify the type of plan ( HMO, PPO, EPO, and Open access plan )
- Limitations and exclusions of the plan
The cost share benefits.
Cost share :
-Deductible
-Coinsurance
-Copayment
-Out of Pocket
The insurance companies I have checked lists :
Aetna
UHC - United health care, UHC Oxford, UMR, Surest, Medica, GEHA
Cigna
Delta Dental
Medical Mutual
Harvard Pilgrim
Quantum Health
Providence
Allegiance
Champva
Emblem Health
BCBS ( All of states ) Federal employee Program
ALLIED
REGENCE
Pacific Source
CARELON
UPMC
Meritain
Providence
Samaritan
etcc..
Codes for Dental Procedures that covered by insurance :
Preventative - D1000-D1999 - Cleanings (prophy), flouride, sealants
Diagnostic - D0100-D0999 - Examinations, X-rays, pathology lab procedures
Restorative - D2000-D2999 - Fillings, crowns and other related procedures
( Private ) or Non covered by the Dental insurance procedures :
Endodontics - D3000-D3999 -Root canals
Periodontics - D4000-D4999 - Surgical and non-surgical treatments of the gums and tooth supporting bone
Prosthodontics- removable - D5000-D5899 - Dentures- partials and "flippers"
Implant Services - D6000-D6199 - Implants and Implant restorations
Mental health codes:
CPT code is 90791 and 90837
