2. ls this the patianfs primary insurance? (Does the payer know about other coverage you are not aware of?)
What type of coverage does the patient have? (For example, some patients have only hospital coverage.)
What is the deductibie amount?
TYPB Of coverage:
Deductible:
5' ) ls the deductible applicable for all services? I1 not, what sen E] Yes D No/Services vices does it cover (for
example, office visits and injections not covered: only)?
Has the deductible been met’? D Yes cw No 1. What percentage will the insurer pay on major medical ex-
medical expenses: penses? On other costs’? % other costs: % Cgjwhat is the amount oi the copayment (if
applicable)? Copayment: S
9' > ls precertification for surgery or hospitalization required? (Insurers who require precertification may deny or
reduce payment ii this step is not taken.)
I1 the p_atiem's coverage is less than a year old, is lha-patient covered for -any preexisfing condition? What
constitutes-a praexisting condition?