Know what the plan pays. Before the patient books.
Photograph the insurance card. Covered checks coverage and finds what the plan pays out of network, with the source next to every answer.
Aetna · Choice POS II
≥ 90% of Medicare
Horizon · NJ Transit
180% of Medicare
Horizon · Direct Access
150% of Medicare
UMR · Choice Plus
80th pct FAIR Health
Cigna · Open Access Plus
Researching plan…
A. R.
Aetna · Choice POS II · checked 2:14 PM
Coverage
Active · out-of-network included
↳ Aetna eligibility reply
OON coinsurance
60%
↳ Member ID card
OON deductible
$8,400
↳ Member ID card
What the plan pays
At least 90% of Medicare
↳ Aetna member disclosure · p.42
Why a floor
Aetna's out-of-network plans pay between 90% and 300% of Medicare. This employer's choice isn't public, so the lowest is the number to count on.
Illustrative patients. Plan figures are real.
Product
The answers a payer call is for. Each one sourced, each one graded.
What the plan pays
The out-of-network basis, such as a percentage of Medicare or a usual-and-customary percentile, with the document it came from.
Graded, never guessed
Established when a source states it, likely when the evidence converges, and a floor you can count on when the plan won't say.
Funding and arbitration
Self-funded or fully insured, from the card and the employer's federal filings, and whether a dispute can go to arbitration.
How it works
Card in, answer out. Minutes, not an afternoon on hold.
- 01
Photograph the card
Front and back, or just the member ID and carrier. Details come back for a glance before anything is sent.
- 02
We check, then research
A live eligibility check with the insurer, then plan documents, carrier policies and federal filings.
- 03
Your team gets the answer
Every line says how sure it is and where it came from, ready to quote to the patient.