How to Verify Health Insurance
Maintain accurate records., Request photo ID and the original health insurance card from the patient., Contact the insurance provider through phone or computer based system to confirm coverage for the patient., Find out whether or not the patient...
Step-by-Step Guide
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Step 1: Maintain accurate records.
Make sure that patient information is up-to-date.
The basic information you should have in the record are patient's name, and date of birth, the name of the person who is the primary insured (commonly the mother’s or father’s name if your patient is a child), social security number, the name and contact information of the insurance provider, and the patient’s insurance ID and group number.If you do not have the information required by the insurance company, and if this information is not accurate, you may not be able to verify the patient’s insurance.
Many factors regarding insurance coverage can change over a short period of time.
Things like birth or adoption of a child, marriage, divorce can affect coverage. -
Step 2: Request photo ID and the original health insurance card from the patient.
Make copies to place in the paper file or scan for electronic filing. , A toll-free number is generally noted on the back of the insurance card, along with other relevant contact information for the health insurance company. , If your patient has an appointment in the future, it is important to clarify whether or not his insurance will be valid on that date.
You can verify this with the insurance company., Your patient will likely have a co-pay and may have certain services which are covered and some that are not.
Clarify this with the insurance company.If there are certain services your patient requires that are not covered by his insurance, make sure the patient understands this. , This refers to whether you, as a healthcare provider, are an in-network health care provider or out-of-network health care provider.
If you are not in the patient’s network, the patient’s insurance may not cover all or any of any services you render., A deductible refers to a set amount of health care costs that a patient must pay before the insurance will begin to pay.
The amount varies, so be sure to verify this amount with the provider.Also be sure to verify whether or not the amount has already been met from other visits (perhaps with other doctors). , Collect any co-pay that is due from the patient, and provide them with a receipt.
The receipt should outline the services provided and the costs so that the patient can verify their own health insurance. , If necessary, contact the insurance provider to verify those items that you are uncertain of, particularly if insurance is new to the patient. , Verification of secondary insurance would include the same steps as mentioned for primary insurance.
Verify specific percentages or amounts covered by the secondary provider. -
Step 3: Contact the insurance provider through phone or computer based system to confirm coverage for the patient.
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Step 4: Find out whether or not the patient will be covered on the date of service.
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Step 5: Clarify the benefit options with the insurance company.
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Step 6: Verify whether the patient is in- or out-of-network.
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Step 7: Find out how much the patient’s deductible is.
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Step 8: Obtain verification of co-pay.
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Step 9: Be prepared to answer patient inquiries about co-pays and coverage.
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Step 10: Ask the patient if they have a secondary insurance.
Detailed Guide
Make sure that patient information is up-to-date.
The basic information you should have in the record are patient's name, and date of birth, the name of the person who is the primary insured (commonly the mother’s or father’s name if your patient is a child), social security number, the name and contact information of the insurance provider, and the patient’s insurance ID and group number.If you do not have the information required by the insurance company, and if this information is not accurate, you may not be able to verify the patient’s insurance.
Many factors regarding insurance coverage can change over a short period of time.
Things like birth or adoption of a child, marriage, divorce can affect coverage.
Make copies to place in the paper file or scan for electronic filing. , A toll-free number is generally noted on the back of the insurance card, along with other relevant contact information for the health insurance company. , If your patient has an appointment in the future, it is important to clarify whether or not his insurance will be valid on that date.
You can verify this with the insurance company., Your patient will likely have a co-pay and may have certain services which are covered and some that are not.
Clarify this with the insurance company.If there are certain services your patient requires that are not covered by his insurance, make sure the patient understands this. , This refers to whether you, as a healthcare provider, are an in-network health care provider or out-of-network health care provider.
If you are not in the patient’s network, the patient’s insurance may not cover all or any of any services you render., A deductible refers to a set amount of health care costs that a patient must pay before the insurance will begin to pay.
The amount varies, so be sure to verify this amount with the provider.Also be sure to verify whether or not the amount has already been met from other visits (perhaps with other doctors). , Collect any co-pay that is due from the patient, and provide them with a receipt.
The receipt should outline the services provided and the costs so that the patient can verify their own health insurance. , If necessary, contact the insurance provider to verify those items that you are uncertain of, particularly if insurance is new to the patient. , Verification of secondary insurance would include the same steps as mentioned for primary insurance.
Verify specific percentages or amounts covered by the secondary provider.
About the Author
Laura Reyes
Brings years of experience writing about pet care and related subjects.
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