MainstreetInsurance verification for specialty practices
Out-of-network benefits in 30 seconds, with a citation
Photograph the card. We verify coverage, find what the plan pays out of network, and judge it against your criteria.
Aetna
Choice POS II
W••••• 46086
Sample Patient
GRP 0141974-010OON DED $8,400
Reading the card
Read from the card
- Insurer
- Aetna
- Plan
- Choice POS II
- Member ID
- W••••• 46086
- Group
- 0141974-010
Your rules
- Coverage active—
- Out-of-network benefits—
- Coinsurance ≤ 50%—
- Deductible left ≤ $5,000—
Reading the card
Figures from a real Aetna Choice POS II plan. Member ID and name are not.
- 1
Photograph the card
The details come back on screen for a glance before anything is sent.
- 2
We check their coverage
A real eligibility check with their insurance company: deductible, coinsurance, and what is left of each.
- 3
Your criteria decide
Accept, review or decline, with the rule that decided it attached.
What an electronic check leaves blank
- What the plan pays out of network
- Self-funded or fully insured
- Whether ERISA applies
- Who has to obtain prior authorization
We answer these from plan documents and federal filings, and cite the source next to each one.
Built to your criteria
- Coverage must be active
- Out-of-network benefits must exist
- Maximum coinsurance you will accept
- Maximum deductible still outstanding
- What happens when the insurer will not say
We set the bar up with you, and every result names the rule that decided it.