1-004.02 SOC and Medical Insurance

When a client with an SOC has medical insurance (including Medicare, worker's compensation, etc.), the following procedures apply:

1. The client or medical provider submits a claim for payment to the insurance company before consideration of the SOC amount;

2. The client or medical provider provides to the worker verification of allowance or disallowance of the claim by the insurance company (i.e., Medicare EOB's, or other insurance benefit explanation forms);

3. The amount that the insurance company allowed must not be counted toward the individual's SOC; and

4. The amount of the claim for which the client is responsible is counted toward the SOC amount.

This procedure applies to all persons whose medical expenses are being used to meet the client's SOC.