Make five labeled boxes. First, eligibility: Is the policy active on the anticipated service date? Second, authorization: Is prior authorization, precertification, or another review required? Third, provider status: Is the specific legal entity and location in network for the relevant service? Fourth, covered services: Which requested category does the plan cover, and what exclusions or limits apply? Fifth, personal responsibility: What deductible, copay, coinsurance, out-of-pocket maximum, and noncovered charges could apply?
For Living Longer Recovery, keep the facility row exact. Public California DHCS records identify Living Longer Recovery, Inc., record number 330022BP, at 68257 Calle Azteca, Desert Hot Springs, CA 92240. Records on file identify residential drug and alcohol detox, a 14-person capacity, co-ed adults, and incidental medical services. Mark those public-record details “confirmed.” Mark current availability, admission, fit, room type, staffing, schedule, medications, insurance participation, and outcomes “needs review” or “not established” until the appropriate source answers them. Do not rewrite the service as “medical detox.” An insurer’s benefit description may also differ from the language in a public facility record, so ask both parties to clarify how the requested service would be submitted and reviewed.
- Eligibility: policy status and effective dates
- Authorization: requirements, deadlines, and decision reference
- Provider status: legal entity, address, service, and network tier checked separately