BCBS

Now that we have reviewed several of the resources we can utilize to check our insurance benefits, we're going to walk through just a couple of sites here to really make sure you are understanding what it is you are looking for. Of course, remember not all of your provider portals will look exactly like the examples I'm showing you here, but you will follow the general steps you see here. 

I am using a Blue Cross Blue Shield of Kansas City for our first example and it’s bluekc.com. This is my local Blue Cross website. We would enter our provider login, which I know I have my own login to access the website. You would want to work with your practice manager or your insurance lead to ensure that you obtain your own login as well. Once you've logged in, you will see a landing page and this is where you will want to select claims and eligibility. As we scroll down here, you'll want to enter the first name and last name of the patient or we can search for them by using their member ID.  

With my local Blue Cross Blue Shield of Kansas City, I know that the majority of member IDs have a three-letter prefix at the beginning. You would enter those three letters here and the remainder of the member ID would be entered here and you will hit submit. This will pull up with your member’s name here, depending on the member ID you enter in or if you did a member name search, it may pull up an entire list of patients with that same name. You want to make sure that your searching or selecting the correct patient.  

Since I know the second patient here was my patient, I'm going to select on her. Looking at this, we see she has active medical insurance. As we go into the details, once again, we want to make sure we've got the right patient selected. Verify the patient name, the member ID the date of birth, and sometimes the member's address and phone number are located. As we look at the bottom here you see we have benefits, medical eligibility, deductibles, and a claim summary. I selected benefits and it will open it into a separate PDF, so now we'll go ahead and look at that PDF here to review exactly what we're looking for.  

Looking here, we know the plan is active and you'll see the plan type and description. This is a PPO plan and members can receive services from any hospital or physician but they receive greater benefits when they use a Preferred Care Blue Network. As I scroll down, I see deductible information. Now this just tells me what the deductible amounts are for this plan. This PDF doesn't tell me how much is met, and I'll show you where to look for that next. You also see an out of pocket maximum. Once that amount has been met, then you see that this insurance will also pay 100%. 

As I continue to scroll, I've also have my coinsurance listed here. And we want to remember, we are looking at the left side which is the in-network provider benefits. Looking here, the patient would pay 10% after the deductible has been satisfied. As we scroll down, we will look under covered services. Diagnostic testing applies to the deductible and then the patient would pay a 10% coinsurance, and this is 10% of the allowed amount. Once the deductible has been met, testing would be paid at 100%. 

We're going to continue looking at our document to see if we can find office visit benefit information. As we look here, we come to our office visit for a primary care physician. Located below that is the specialist benefit information. 

With this plan, the patient has a $25 specialist copay for the first four office visits in the calendar year. Any visits over four, the office visit applies to the deductible, and then the patient would pay 10% once their deductible has been met.  

As we continue to look at our document, we’ll continue to scroll on down here a little bit more. This plan has a pediatric vision benefit, which means if the patient is 18 and under, they have a $25 copay for a routine eye exam. If providing the patient with a comprehensive eye exam, you will bill with a refractive diagnosis for a $25 copay, once per calendar year.  

This benefit also reads that they have eyewear benefits under the pediatric vision. We will want to send those materials with a refractive diagnosis and we will want to check with the plan specifically to see how this would need to be billed.  

As we scroll down here, if a patient's medical covered routine vision care, not just pediatric like we just reviewed, it would say either routine vision or vision care right here. We would want to see what exactly these benefits are.  

This plan does not have any routine vision benefits aside from the pediatric vision benefit. After reviewing your benefits in its entirety, you will want to ensure that you document your findings in your patient's account with a date of when you reviewed it.  

Within my insurance screen, or appointment notes you will want to enter:  

No routine vision, Med Dx $25 – this means no routine vision benefits and specialist copay was $25. You will also want to enter deductible and coinsurance information, if applicable. 

Okay so, once we’ve scrolled through our benefit document, we will want to review deductible information as well. On this page, you see that $1750 has been applied to this patient's deductible, with the amount remaining is zero. This tells me this patient has met their deductible.