How are inpatient benefits paid?

Sidecar Health pays a fixed Benefit Amount for covered, medically necessary services. In most cases, providers bill for specific medical codes to describe treatments and services (such as CPT codes) or diagnoses (such as ICD codes) and Sidecar Health reimburses for each individual medical code at the line-item level.

In the case of inpatient care, when you’re admitted to the hospital and likely staying overnight, providers bill in the form of a diagnosis-related group (DRG). The diagnostic-related group (DRG) system categorizes different medical codes. Hospital services are categorized based on a diagnosis, type of treatment, and other criteria for billing purposes. A DRG represents a list of other codes. Instead of reimbursing at the line-item level, Sidecar Health uses the DRG system to determine the appropriate Benefit Amount for the DRG payment. 

Submitting a pre-bill to Sidecar Health in advance of getting care will help you get an accurate estimate of your Benefit Amounts – ask your provider for a detailed itemized estimate (often referred to as a “good faith estimate”).