Provider Benefits Verification Calls

When a Provider (doctor's office) calls in for a "benefits check" or to verify benefits, there is some specific information that they are looking for. Here is the basic list of what they need:

  • Deductible
    • Individual
    • Family
  • OOPM (Out of Pocket Max)
    • Individual
    • Family
  • Effective Date
    • The date that the plan became effective 
  • Coinsurance
    • Normal coinsurance for most plans is 90%
  • Copays
    • $25 for Primary care visits
    • $50 for Specialist Visits

The providers office will want to know if they have met any of their deductible or their OOPM.  They may also call this accumulations. 

Occasionally they will want to know if certain codes are covered under the plan. We do not have the ability to look up codes, however, if it is some sort of procedure or therapy, normally the provider will need to get preauthorization.

INETICO is the preauth "department" you can transfer them to Inetico at 877-608-2200. 

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