Certified Revenue Cycle Representative (CRCR) Practice Exam

If an insurance verification response indicates that a subscriber has a single policy, what is the status of the subscriber's spouse?

1. Enrolled and entitled to benefits

2. Uninsured

3. Neither enrolled nor entitled to benefits

4. Dependent with partial benefits

The correct answer is: Neither enrolled nor entitled to benefits

When an insurance verification response indicates that a subscriber has a single policy, it typically means that the policy is solely under their name and does not extend coverage to anyone else, including a spouse. In this context, the status of the subscriber's spouse would be that they are neither enrolled nor entitled to benefits under that particular policy. It’s important to understand that insurance policies can vary significantly, and many individual insurance plans do not provide coverage for spouses unless they are specifically included as dependents. A single policy suggests that only the subscriber is covered, leaving the spouse without access to benefits under this insurance plan. Understanding this concept is critical for accurately managing patient accounts and ensuring that individuals are informed about their insurance coverage and any potential need for separate policies or alternative insurance options.