What is a Processor Control Number on a health insurance card?

A processor control number on a health insurance card is used by a pharmacy to handle prescription drug claims. The PCN number tells the pharmacy where to route your claim for reimbursement. Not all insurance companies use processor control numbers, so your health insurance card may not have one.

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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Written by Jeffrey Johnson
Insurance Lawyer Jeffrey Johnson

UPDATED: Jan 5, 2022

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Overview

  • The processor control number helps pharmacies to route prescription claims
  • Not all health insurance companies use a PCN
  • Your health insurance card is all you need to present to a provider in order to get coverage

Take a trip to your doctor’s office, and one of the first questions they’ll ask is:

Can I see your insurance card?

Health insurance protects you from having to pay large sums of money out of pocket when you undergo medical visits and procedures. And it’s your health insurance card that can provide your doctor’s office with everything they need to know about your specific policy. Your health insurance card contains important information, including the Processor Control Number.

So what is a Processor Control Number on a health insurance card, and what does it do?

If your doctor prescribes medication during your visit, your pharmacy will use your health insurance card to route the claim to your insurance company. The processor number helps them to do that quickly.

Read on to learn more about the Processor Control Number on your insurance card. But before you do, enter your ZIP code for fast, free health insurance quotes.

How Processor Control Numbers Work

A Processor Control Number is a secondary identification or member ID number used specifically for routing pharmacy reimbursements. Because your health insurance policy will likely cover some or all of your medication’s cost, it’s crucial to provide your pharmacy with that processor number when you pick up your prescription. That way, you don’t have to pay for the entirety of your prescription out of pocket.

When looking at your insurance card, you’ll see your Processor Control Number listed after “RxPCN.” Your specific processing control number may be alphanumeric or numeric.

Your pharmacy will use this number, as well as your bank identification number (BIN), to process your prescription drug claim. While the BIN is used to tell your pharmacist which insurance provider you have a policy with, the PCN is used to route the claim.

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What if your health insurance card doesn’t have a Processor Control Number?

Don’t worry if you’re looking at your insurance card but can’t find your PCN. Not every health insurance provider uses Processor Control Number.

To confirm that your specific provider doesn’t use PCNs, you can contact your insurance company to check your accounts details.

Why Do You Need a Health Insurance Card?
If you already have a health insurance policy, you may wonder why you need a health insurance card. Essentially, a health insurance card functions as proof of your insurance. Its identifying numbers also allow your healthcare providers to look up your policy information.

But your health insurance card doesn’t only serve your medical providers. For you, the cardholder, a health insurance card provides a quick reference to your policy information. Most insurance cards can tell you:

  • What type of plan you have
  • What benefits are included
  • The cost of your copay and deductibles

By carrying your insurance card and understanding how to read it, you’ll always be prepared to get the healthcare you need without being blindsided by unexpected medical fees.

What other information can you find on your insurance card?

Aside from your BIN and PCN, your health insurance card will likely contain other vital information about your policy, including:

Name of the insured – If you’re the owner of the insurance policy, your name will be on the insurance card. If you’re on a family member’s insurance policy, both names will appear on the card, with the policyholder’s name appearing first. Dependents’ names may not appear on the card.

Identification number – This is a unique number that identifies the insured.

Group number – If you receive health insurance through your employer, your health insurance ID card will show a group number. This number is similar to your identification number, but rather than identifying the insured, it identifies your employer’s insurance package.

Your insurance plan type – There are different types of health insurance plans, and not all coverage is the same. Therefore, there will be an acronym identifying your insurance plan type on your health insurance card. This will help you to identify in and out-of-network providers.

Your plan number – Your plan number shows which specific plan you have with your provider.

Benefits – Your specific benefits, including medical, vision, or dental, may also appear on your insurance card.

Costs – Your card will likely show information regarding your deductibles and copays for both in-network and out-of-network providers.

Provider contact information – Provider contact information can also be found on your insurance card. Use this information to contact your insurance company if you have any questions about your plan or need help finding a doctor.

Do you need to carry your health insurance card all the time?

Even if you’re not planning to visit your doctor’s office anytime soon, it can be beneficial to always have your insurance card on you, just as you would with your driver’s license. This way, if any unforeseen medical emergencies occur, you’ll be ready with all the necessary insurance information.

Fortunately, health insurance cards are usually wallet-sized and can be stored with your other ID cards or credit cards. You can also keep a photo of your health insurance ID card stored on your smartphone in case you ever lose your physical copy.

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Choosing Your Health Insurance Policy

Understanding the health insurance landscape and considering your personal medical needs are crucial to finding an insurance policy that’s right for you. When deciding on a plan, you’ll want to consider several different factors, including the plan type, category, and cost.

Health Insurance Plan Types

While there are variations from company to company, health insurance policies generally break down into the following categories:

Health Maintenance Organization (HMO) – This policy only covers care provided by in-network doctors and hospitals. If you have this type of policy and need to see a specialist of any kind, you’ll likely need a referral from your primary care physician.

Exclusive Provider Organization (EPO) – In most cases, this policy also only covers providers in your network. However, you may not be required to get a referral if you need to see a specialist.

Preferred Provider Organization (PPO) – With this policy, your insurance can help you cover the cost of visits to both in-network and out-of-network providers. However, you’ll likely have to pay more for out-of-network care.

Point of Service (POS) – This type of policy combines aspects of other policies to varying degrees. For instance, you may need a referral to see a specialist, but you may also receive health coverage for out-of-network providers (at a slightly higher cost).

Even with these categories, it’s important to note that there are no industry-wide definitions of plan types, so your plan’s specifics may vary depending on your provider and the state in which you live. Before deciding on a plan type, be sure to research individual policies with specific providers to find the plan best suits your needs.

Health Insurance Plan Categories

Within each plan type, health insurance policies on the marketplace come in four levels:

  • Bronze
  • Silver
  • Gold
  • Platinum

But don’t be fooled into thinking a platinum plan is automatically the best. According to Healthcare.gov, “Metal categories are based on how you and your plan split the costs of your health care. They have nothing to do with the quality of care.”

However, these metal categories do operate on a spectrum. At one end of the spectrum, bronze plans have the lowest monthly premiums but the highest out-of-pocket costs. On the other end of the spectrum, platinum plans will allow you to pay the least amount of money when receiving medical care but require the highest monthly premiums.

Ultimately, you’ll have to perform a cost-benefit analysis and assess your unique situation to see which plan category is right for you.

Health Insurance Costs

Health insurance costs can take several forms, including premiums, deductibles, and copayments. The amount you’ll have to pay for each of these costs will depend on your specific plan. While some plans offer lower costs in certain areas, such as deductibles, these savings usually come at the expense of higher costs in other areas, such as your premium.

To choose the health insurance plan that’s right for you, take a moment to understand what each of these categories covers.

Premium – This is the monthly payment you make to your insurance provider, regardless of whether or not you receive medical care that month.

Deductible – This is the amount you have to spend out of pocket on your medical care before your insurance company steps in to cover any costs. Your deductible resets every time you renew your healthcare plan (typically once a year).

Coinsurance or copayment –  There’s a difference between coinsurance and a copayment. Coinsurance is a percentage of the cost of care that you have to pay out of pocket. A copayment is a fixed amount you have to pay your for medical care. Both apply even after you’ve reached your deductible in most cases.

Processor Control Numbers and Finding the Best Policy

The world of health insurance revolves around confusing acronyms, long strings of numbers, and significant variations between providers and their policies. Does the processor number on your health insurance card have anything to do with finding the right coverage?

The good news is, that number only matters when a pharmacy is processing your prescription, and for the most part, you don’t need to worry about it.

In other good news, you don’t have to be well-versed in health insurance jargon to find the most beneficial and affordable plan for your healthcare needs.

Don’t worry about processor numbers for health insurance, and instead focus on getting the best coverage at the right price. Enter your ZIP code to get free health insurance quotes today.

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