As a health care provider, it’s essential to learn how to properly verify health insurance before extending services to patients. In order to get paid for the services rendered, you have to verify the patient’s plan and coverage on your own. This way, you know for sure what types of services are covered and whether you’re in their network.
There are instances where medical billing and coding specialists accidentally send the claim to the wrong insurer, which delays the processing. It only takes a few minutes to verify health insurance, compared to waiting days or weeks to fix a mishap in billing. Your accounts receivable department will save hours that would otherwise be spent chasing down claims.
So what does it take to verify a patient’s health insurance?
Read the Insurance Card
There are details on insurance cards that provide essential information about each patient’s coverage. Commercial insurance companies make it easy to determine what type of plan a patient has, such as a TPA or PPO. You can review the patient’s insurance card to find phone numbers to their providers as well. This can be used to get more information about the plan benefits offered. Commercial insurers also sometimes include a website where you can go to verify benefits and eligibility.
When it comes to self-funded companies, you can find a benefit and eligibility numbers and the addresses to where all claims should be sent. You can also verify the logos on the card to help you identify the networks it belongs to.
Give the Payer or Network a Call
It’s good to verify a patient’s coverage by contacting the payer and/or network. Your best bet is to contact the payer first. The payer can supply you with ample details regarding the benefits of the plan and the in-network and out-of-network coverage. They can also educate you about any remaining coinsurance responsibilities, deductibles and co-pays. If you are within a specific network, such as a PPO, make sure that PPO benefits are available.
If after speaking to the payer you still have doubts, you can get in touch with the network. Here, you can verify that the payer is within the same network the provider has a contract with. If the provider is PPO only, make sure the plan is enrolled in a PPO network.
New and Returning Patients
When a new patient contacts your office to make an appointment, it’s important to discuss payment options and insurance coverage. It’s recommended that paperwork be filled out prior to the first appointment to help save you, the physician, and the patient time. This is where you can collect information about their insurance plan so you can verify payment details ahead of time. Make sure to ask the patient who will be responsible for paying the bill, other than their insurer.
It’s also important to keep returning patients’ insurance information updated. Policies have to be renewed each year and sometimes patients simply stop paying and end up having their policy canceled. Have patients verify their current address, contact info and insurance coverage at each visit.
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