Describe the ways that benefits for x-rays and labs are handled

Question

What will be an ideal response?

Answer 1

Answer:
Benefits for x-rays and labs can be handled in a variety of ways. In the past, it was not uncommon to have what was called a "scheduled benefit." This type of benefit specified that a set dollar amount was allowed for each test. Today, most Basic Benefit plans provide an alternative type of benefit called an "unscheduled" Basic Benefit, which limits payment under the Basic Benefit to a specified dollar amount per policy year based on UCR or based on a conversion factor and RVS units. Once the policy year maximum has been paid, subsequent expenses would be paid under the Major Medical benefit.
If a Basic DXL benefit is provided by the plan, inpatient charges are usually excluded. That is, inpatient expenses would be covered only under Major Medical benefits. However, outpatient hospital claims would allow a Basic Benefit for DXL charges. Therefore, it is important to read the insurance plan before determining benefits. With the advent of electronic billing, it is likely the computer software provided by the insurance company will determine the amount covered in various circumstances.