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    746572 Companion Economy ID Card

    Uploaded by

    Harry Frank

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    746572 Companion Economy ID Card

    Uploaded by

    Harry Frank
    10 views1 page

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    10 views1 page

    746572 Companion Economy ID Card

    Uploaded by

    Harry Frank

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    P0746572

    Insured by:
    NO PPO REQUIREMENTS Send Claims To: BIN: 018729
    All licensed medical providers accepted PCN: GBX *
    Provided by Pivot Health Insurance Benefit Administrators c/o Zelis
    Insured Spouse: Box 247 Alpharetta, GA 30009-0247 GRP: HCHRX
    Member Name:
    Dependent(s):
    Harry Frank EDI Payor ID: 07689
    Member ID: P0746572 For Claim & Benefit Questions:
    Effective Date: 09/24/2024 Client Services: 844.630.7500
    Primary Care Office Visit Copay: Benefit Verification: 866.323.2985
    Specialty Doctor Office Visit Copay: Pre-certification: 866.317.5273

    All hospitalizations, other Inpatient care, and Surgeries or Surgical Procedures


    Prescription Drug Help Desk: 844.636.7506
    must be Pre-certified.
    Reimburses up to 125%/150% of Medicare for Physicians/Facility fees. This Possession of this card does not guarantee eligibility or payment of benefits.
    short term medical coverage is not subject to Affordable Care Act Requirements. *CerpassRx discount is not insured by Companion Life Ins. Co.

    Benefit Verification Instructions for Providers


    Step-by-step process for submitting claims
    1. Your patient will provide you an ID card for their short term medical plan. Pivot Health plans are
    underwritten by insurance carrier Companion Life Insurance Company.
    2. This fully-insured insurance plan has no PPO network restrictions or requirements. All licensed
    healthcare providers are accepted.
    3. Payment is up to 25% more than what Medicare pays for doctor office visits and up to 50% more
    for facilities.
    4. If you would like to verify insurance benefits, contact the benefit verification line: 866-323-2985.
    5. Copay plans (when applicable) can be collected at the time of service for the office visit.
    6. Medical claims can be sent to: Insurance Benefit Administrators c/o Zelis, Box 247, Alpharetta, GA
    30009-0247
    EDI Payor ID: 07689

    Pre-Certification Requirements
    1. All hospitalizations, other Inpatient care, and Surgeries or Surgical Procedures must be Pre-
    certified.
    2. To comply with the Pre-certification requirements, the Covered Person must:
    a. Contact the pre-certification review agent at the telephone number contained in the Insured’s
    certificate or ID card as soon as possible before the expense is to be incurred; and
    b. Comply with the instructions of the pre-certification review agent and submit any information
    or documents they require; and
    c. Notify all Doctors, Hospitals and other providers that this insurance contains Pre-certification
    requirements and ask them to fully cooperate with the pre-certification review agent.
    3. In the event of an emergency Hospital admission, Pre-certification must be made within 48 hours
    after the admission, or as soon as is reasonably possible.
    4. Pre-certification Does Not Guarantee Benefits – The fact that expenses are Pre-certified does not
    guarantee either payment of benefits or the amount of benefits. Eligibility for and payment of
    benefits are subject to all the terms, conditions, provisions and exclusions herein.
    5. Concurrent Review – For Inpatient stays of any kind, the pre-certification review agent will Pre-
    certify a limited number of days of confinement. Additional days of Inpatient confinement may later
    be Pre-certified if a Covered Person receives prior approval.

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