1. Should the gender rule be used to determine primary insurance for dependent children? Why or why not?
Sure that you understand how your benefits coverage works when you have multiple insurances.
A few simple guidelines to assure maximum benefit are:
If you have other insurance, then … Highmark sends you a Coordination of Benefits (COB) questionnaire to determine which plan is primary.
If services are rendered to you, and you are the employee under the plan, then… Your plan through your employer is the primary plan for you.
If services are rendered to your spouse, who has a policy through another insurance carrier, then… Your spouse's own policy is the primary plan for your spouse.
If services are rendered to a dependent, covered by both parents' policies and both policies, have the birthday rule, then… Coverage for the parent whose birthday falls earliest in the year (month and day) is the primary plan.
If services are rendered to a dependent who is covered by both parents' policies and both policies, has the birthday rule, and both parents are born on the same month and day, then… The primary plan is the policy that covered the patient for the longest period of time.
If one insurance company follows the birthday rule and the other follows the gender rule, then… The policy with the gender rule dictates the father's coverage to be the primary plan.
If parents are divorced, and there is a court order stating which parent is primary, then… The policy of the parent listed on the court order is the primary plan.
If parents are divorced and no court order, then… The parent with custody is the primary plan.
If parents are divorced and parents with custody remarried, then… The plan of the stepparent with custody is primary over the natural parent without custody.
1. Should medical insurance policies restrict certain excluded services? Why or why not?
2. For the average patient, which would be the preferred health insurance plan, indemnity or managed care? Why?
1. Under what types of circumstances might medical insurance specialists need to utilize GEMS?
2. Why is it important for WHO to standardize codes to be used worldwide?
5. Explain why a physical status modifier must be used with anesthesia codes.
3. Why can't the provider simply code office visits by time spent with the patient?
3. Should spouses have the right to view each other's medical record without authorization?
4. While on a skiing vacation, you break your leg and are treated by a local provider. Upon your return home, your PCP removes the cast. Explain why or why not to use bundled code.
4. The code numbers are listed in the Alphabetic Index. Why not code directly from it?
2 If a patient has bunions on both feet repaired during the same operation, why must you use modifier 50?