High Deductible and IBCCP • Effective 7/1/2015 Effective 7/1/2015 • Insurance covers screenings but Insurance covers screenings but a a deductible deductible must be met for diagnostic procedures. must be met for diagnostic procedures. • IBCCP will cover the cost of diagno IBCCP will cover the cost of diagnostic stic procedures up to the unmet procedures up to the unmet deductible for deductible for accepted CPT codes. accepted CPT codes. • This does not apply to copays. This does not apply to copays.
Does everyone with insurance qualify? No, all IBCCP eligibility and requirement guidelines must No, all IBCCP eligibility and requirement guidelines must be met, except for insurance coverage. be met, except for insurance coverage. This includes individuals: This includes individuals: • 35 – 35 – 64 years of age 4 years of age • Resident of Illinois Resident of Illinois Medicaid spend down is treat Medicaid spend down is treated as an insurance deductible. ed as an insurance deductible.
What qualifies as a “high deductible?” • Any amount that Any amount that would cause the would cause the client a client a financial hardship. financial hardship. • This is not for you or PSWH to decid This is not for you or PSWH to decide, it is up e, it is up to the client. to the client.
Remember… • Diagno Diagnostic workup must foll stic workup must follow the IBCCP guidelines. ow the IBCCP guidelines. • Diagno Diagnostic services should stic services should not be delayed. not be delayed. • The enrollment packet must still be completed. The enrollment packet must still be completed. • To avoid delay, these activities may happen To avoid delay, these activities may happen simultaneously. simultaneously.
Who gets the bill? • The insurance company The insurance company goes first. goes first. • An An estimate of estimate of benefits (EOB) benefits (EOB) is generated. is generated. This should This should include the unmet deductibl include the unmet deductible amount. amount. • IBCCP IBCCP is next. is next. Please include a Please include a copy of the EOB, along with the copy of the EOB, along with the HCFA and UB. HCFA and UB. • Payment Payment is made according is made according to establi to established CPT codes and rates hed CPT codes and rates based on based on the highest allowabl the highest allowable Medicare rates for Illi e Medicare rates for Illinois. nois. • The patient cannot be balance billed after insurance and The patient cannot be balance billed after insurance and IBCCP IBCCP payments. payments. If cancer If cancer is diagnosed, treatment is diagnosed, treatment cost would be deferred to the cost would be deferred to the client’ client’s insurance coverage. insurance coverage.
Questions & Answers • Can copays be paid on clients with high deductibles? Can copays be paid on clients with high deductibles? No • Can the unmet portion of the Can the unmet portion of the bill be billed to client? bill be billed to client? No, the balance must be written off according to the IBCCP contract. • What What information do you information do you need to send to need to send to PSWH? PSWH? Copies of all reports starting with the office visit, screening/diagnostic cycle.
Questions & Answers • Is there a Is there a maximum or minimum amount for the maximum or minimum amount for the high deductible patient? high deductible patient? No. • Is there a cap on your hi Is there a cap on your high deductible that gh deductible that IBCCP IBCCP would cover? would cover? No
Questions & Answers • If insurance pays a portion of If insurance pays a portion of the screening service, can the screening service, can IBCCP pay the difference? IBCCP pay the difference? Yes, if a client has insurance that only pays a portion of the screening service IBCCP can pay the differences up to the amount of the established/allowable IBCCP CPT Codes rates.
~When: November 17 ~When: November 17 th th , 2016 , 2016 ~Topic: Clinical Navigation Insured ~Topic: Clinical Navigation Insured If you know If you know of an agency of an agency or an indivi or an individual dual who who may may be interested in becoming a be interested in becoming a member of member of our our coaliti coalition, please let us n, please let us know. know.
If there’s a topic that you If there’s a topic that you would like to learn more would like to learn more about, please let us know. about, please let us know.
We appreciate you attending We appreciate you attending our webinar! our webinar! Our success requires Our success requires your support. your support.
Prairie State Women’s Health Prairie State Women’s Health 1-800-721-7734 or 1-800-331-1689 1-800-721-7734 or 1-800-331-1689 E-mail: E-mail: PrairieStateWH@outlook.com PrairieStateWH@outlook.com www.facebook.com/PrairieStateWH www.face book.com/PrairieStateWH www.montgomeryco.com/health www.montgomeryco.com/health Physical Phys al Add Address: Prair Prairie State Women’s Health e State Women’s Health Montgomery Montgomery County Health Department County Health Department New Contact Information as of 9/1/16: New Contact Information as of 9/1/16: 11191 Illino 1119 Illinois is Route 185 Route 185 Kayla Hilt, Public Health Nursing Supervisor Kayla Hilt, Public Health Nursing Supervisor Hillsboro, IL 6 Hillsboro, I 62049 049 Frankie M Frankie Malloy, lloy, Administrative/Billing Administrative/Billing
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