Routine care is usually not provided to patients with questionable eligibility until the

• A. Patient provides other identification
• B. Patient pays for treatment
• C. Patient's eligibility is determined
• D. Patient provides proof of insurance

Answer: (C)

The main idea is that confirming whether a patient qualifies for coverage is the gatekeeper for routine care when eligibility is in doubt. Until a determination is made about whether any payer will cover the services and under what terms, routine care isn’t routinely provided because without that clarity the facility could face unpaid costs or misbilling. Identification and proof of insurance are important steps in the process, but they don’t by themselves establish whether the patient actually qualifies for coverage. Paying out of pocket isn’t the standard trigger to proceed with routine care when eligibility is uncertain. Once the eligibility is determined, the appropriate billing and coverage details are known, and care can proceed with clear expectations about payment or coverage.