The information provided is not a guarantee of payment and is based on the following assumptions:
• The patient is still covered by the plan at the time of service.
• Member's premium payments are current for the dates of service.
• There are no changes to the plan benefits that cover the patient on the dates of service.
Claims payment is subject to all provisions of the plan document, including limitations and exclusions. Some services may require preauthorization and is the member's responsibility to complete prior to attending. Procedure codes are subject to review by member's insurance for appropriate billing standards.
For additional information, please contact the Member's Benefits number.