Save reception hours of hold time.
Out-of-network benefits verified in minutes, not hours. Photograph the card and every answer comes back with its source.
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.