How to Verify Patient Insurance

How to Verify Patient Insurance

When in medical school, you assume that the toughest parts of being a care provider will be weeding your way through complex symptoms to come to a diagnosis. And, yeah, that certainly is challenging, but once you go into practice, you discover that the administrative side of things can deliver the biggest headaches.

Medical insurance verification, for example.

When done improperly, it leaves patients on the hook for the full cost of treatment or delays them receiving the services they need. Neither of these reflect well on you as a provider. So, let’s take a quick look at how to check insurance benefits for your patients.

Start by Collecting Patient Information

How do you verify medical insurance? To start with, you need accurate information about the patient. Before making the call, have this data on hand:

  • Patient name
  • Patient date of birth
  • Name of the insurance company
  • Phone number and address of the insurance company
  • Name of the primary plan holder and their relationship to the patient
  • Policy number
  • Group ID if applicable

Contact the Insurance Provider

This should be done at least one day before the patient’s visit since the verifying patient insurance process can get complicated. This gives you more time to get the answers you need ad ensures you know the limits of the patient’s coverage before the appointment. There are a few ways you can get in touch with insurance companies:

  • By Phone: This is typically the simplest but most time-consuming method for verifying insurance coverage. You just call the insurance company ensure you are on the provider services line, and walk through their steps to get the information you need.
  • On the Provider’s Website: Most insurance providers have online eligibility-checking Some of these are more difficult to navigate than others, so how much time this might save you varies wildly.
  • Via Online Portals: Some companies also have online portals where you can contact them directly and have them confirm patient benefits. These let you skip the calls and the searching and are typically the easiest option, though there is no telling how fast the response will be.

Get the Information You Need

The last step in how to do insurance verification is get the information your practice needs to ensure your scheduled service is covered. Questions you might want to ask the representative include:

  • What is your claims address?
  • Is the policy active, and to what date?
  • What is the patient’s copay or coinsurance?
  • What is the patient’s deductible?
  • Does the patient need a referral or pre-authorization for treatment to be covered?

Ultimately, medical insurance verification can be difficult to manage. Automation is often the solution. To learn more about software for insurance verification or healthcare SEO services, contact Sequence Health.