Verifying BCBS
Purpose
To verify a patient’s active BCBS coverage, review deductible, out-of-pocket, coinsurance, copay, and visit limits, and communicate the patient’s estimated responsibility for chiropractic services.
When
Use this process when a patient has BCBS insurance and the office needs to confirm benefits before scheduling, checking in, or discussing payment options.
Who
This process should be completed by the front desk, insurance verification coordinator, or designated team member responsible for eligibility and benefit checks.
Procedure
1. Log in to the BCBS portal
Log into the BCBS insurance portal using office credentials.
2. Go to Health Eligibility
Once logged in, go to Health Eligibility.
3. Enter patient information
Type in the following:
- Member ID
- First Name
- Last Name
- Date of Birth
Then click Search.
Note: Certain members may come up automatically if their BCBS plan is from North Carolina.
4. Review coverage details
Once the patient record opens, acknowledge and review:
- Deductible amount
- Out-of-Pocket amount
- Co-Insurance
Important note:
- Once the out-of-pocket maximum is met, the patient is covered at 100%
5. Review Rehab/Therapy Services
Scroll to Rehab/Therapy Services and click into Chiropractic.
6. Confirm copay, coinsurance, and visit limit
Under Chiropractic, review:
- Copay
- Coinsurance
- Visit Limit
BCBS Deductible Patient Fee Guidelines
7. Use office fee guidelines for deductible patients
For BCBS deductible patients, use the following fee amounts:
(without X-rays)
New Patient / Re-Exam Visit: $83.85
- Regular Office Visit: $67.85
- 20% Co-Insurance: $16.67
8. Self-pay election requirement
If the patient chooses to do self-pay instead of using insurance, they must sign the:
ENF (Election Not to File)
Purpose: Documents that the patient is choosing not to have the office file insurance for services.
Documentation
After verifying benefits, document the following in the patient chart or benefit notes:
- Insurance verified
- Deductible amount
- Out-of-pocket amount
- Coinsurance or copay
- Visit limit
- Whether patient is using insurance or self-pay
- Whether ENF is needed or signed, if applicable
Purpose: Keeps a clear record for scheduling, billing, and patient communication.
Quick Reference
- Go to Health Eligibility
- Enter Member ID, first name, last name, and date of birth
- Review deductible, out-of-pocket, and coinsurance
- Go to Rehab/Therapy Services > Chiropractic
- Confirm copay/coinsurance and visit limit
- For self-pay, patient must sign ENF
Standard Patient Estimates for BCBS Deductible Patients
- New Patient/Re-Exam: $83.85 without X-rays
- Regular Office Visit: $67.85
- 20% Co-Insurance: $16.67