Verifying Patient Insurance Benefits

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verify patient benefits

Before you provide care, it’s imperative to confirm how a patient will pay for your services. In cases where patients are covered by an insurance plan, it’s equally important to verify their insurance eligibility before you provide any care. Failing to do so could leave you with an unpaid claim by the insurance company or a patient unable to pay their bill in a timely manner.

Depending on the size of your health care facility, or whose management you’re under, you may have a team of insurance and compliance employees who handle payment and insurance issues and are adept at managing and processing claims with the insurance companies. But if you don’t, there are some important procedures to follow that will help you facilitate this fundamental part of running a health care office.

New Patients

When a prospective patient calls to make an appointment, take time to discuss payment and insurance coverage with them. Supplying new patient paperwork prior to a first appointment is an efficient business practice that can save you and your patient’s time. This paperwork should include a form designed specifically to collecting insurance information, as well as a statement regarding payment responsibility. It’s pertinent to outline the payment options you offer and require the patient to verify who is responsible for their bill, aside from any insurance they have. You may have a website where the forms can be accessed, or simply send them via email.

In order to confirm insurance eligibility, your insurance information form should ask for:

  • Patient’s name and date of birth
  • Name of the primary insured
  • Social security number of primary insured
  • Insurance carrier
  • ID number
  • Group number
  • Contact information for the insurance company including phone number, website and address for submitting claims

 

Once you’ve got the insurance information in-hand, you should contact the insurance company to verify the following pieces of information:

1. Patient is indeed covered by the insurance

2. Insurance coverage effective dates

3. In-network or out-of-network coverage

4. Service(s) you are seeing the patient for are covereddo they need pre-authorization and/or a referral by a primary care physician?

5. Amount of co-pay for services, if any

6. Deductible amounthas the deductible been met for the year?

When the patient arrives for their appointment, you’ll want to make a copy of their photo ID and their insurance card and collect any applicable co-pay.

Returning Patients

It’s also important to keep your returning patients’ records up-to-date. Personal information, like address, contact information and insurance coverage can change over a short period of time, so always have your patients verify their personal information each time they visit your office. If a returning patient indicates a change in insurance, follow the procedure to verify their benefits prior to providing care.

Having well organized procedures for collecting patient information and verifying insurance eligibility will help facilitate a streamlined claims and billing process. There are sophisticated verification tools available that automate much of the process, but as long as you follow some basic protocol, you’ll help to ensure timely payment for your services.

 

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