Verify Health Insurance: There may be various reasons why you would have a need to verify health insurance.
You may be a medical provider verifying insurance for a patient.
Or a patient checking to make sure that your insurance is covering what it should.
Use these steps to verify primary and secondary health insurance.
Verify Health Insurance
1. Maintain accurate records.
Make sure that patient information is up-to-date.
- The basic information you should have in the record is the 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.
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.
Verify Health Insurance
3. Contact the insurance provider through phone or computer based system to confirm coverage for the patient.
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.
4. Find out whether or not the patient will be covered on the date of service.
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.
5. Clarify the benefit options 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.
6. Verify whether the patient is in- or out-of-network.
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.
7. Find out how much the patient’s deductible is.
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).
Verify Health Insurance
8. Obtain verification of co-pay.
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.
9. Be prepared to answer patient inquiries about co-pays and coverage.
If necessary, contact the insurance provider to verify those items that you are uncertain of, particularly if insurance is new to the patient.
10. Ask the patient if they have a secondary insurance.
Verification of secondary insurance would include the same steps as mentioned for primary insurance.
Verify specific percentages or amounts covered by the secondary provider.
Verify Health Insurance
11. Maintain detailed health care records.
It is important that you have a record of the treatments you received and when. You can do this by keeping a file in a filing cabinet, or you can keep a digital record, for example in an Excel sheet. Either way, you should have detailed information listing amounts paid, purpose of visit, surgeries, preventative care (such as dental cleaning), etc.
- If you are missing information, you can request the missing information from your doctor.
12. Keep your health insurance provider informed of any life events.
Certain life events may affect your coverage. Therefore, it is important to keep them updated on certain events (e.g if you get married, have a baby, adopt a child). If the insurance does not have accurate records, and later finds out that you failed to inform them, they may refuse to pay for your medical care. You may also end up paying more than you need to.
13. Read the information you received from your health insurance provider carefully.
When you enrolled in your health insurance plan, you probably received a packet of information describing your plan, what it covers, what it doesn’t, how much your deductible is, etc. Read this thoroughly so that you understand the details of your coverage.
Verify Health Insurance
14. Arrange an appointment with a representative of your insurance provider.
If there is anything you do not understand, or want clarification on, schedule an appointment with a representative. This way, the representative will have adequate time to explain, clarify, and answer any questions you have about your coverage.
15. Call your insurance company.
Before scheduling major procedures, it is a good idea to give your provider a call. Make sure that there are no problems with your insurance and that no additional information is needed. Find out if and how much of the cost of your procedure will be covered. By doing this, you won’t have an ugly surprises once your procedure is completed.
Verify Health Insurance
16. More tips
-
Take time to review new policies and procedures submitted to you by health insurance providers. This simple practice can help save hours of time in verifying health insurance.
-
Keep all medical receipts and records together in 1 file or folder. This allows easy access when addressing an insurance problem or coverage question.
-
Be patient when dealing with insurance providers. Although their methods of calculating invoices may be different than yours, most of the time they are accurate.
-
As a patient, you can also discuss payment plans with your doctor’s office in the event that insurance will not cover all or, or any of a procedure.
Related Articles
- 20 Ways on How to Get Pay Rise in any Establishment.
- 39 Tips Launching Your Own Business Consulting Venture: Key Steps to Success
- 29 Tips Harnessing the Power of Off-Grid Solar Electricity: A Sustainable Energy Revolution
- 12 Tips to Start Locally Made Animal Feed Production
- How to Choose the Highest Output Solar Panel in Nigeria
- 28 Tips to Start Mobile Home Appliances Maintenance
- 35 Top Affordable Online Graphic Design Schools: Your Path to Creativity on a Budget
- 23 Tips Mastering the Art of Selling Peloton Apparel: Strategies for Success
- 25 Best Power of Enterprise Ecommerce Platforms: Accelerating Growth and Efficiency
- Top 50 Food Businesses to Open in Nigeria
- 20 Best Hospice Home Care: What to Expect
- 18 Tips to Make Essential Oils Perfume Products
- Understanding Financial Risks in the Business
- 47 Best Ways to Open Beauty Gift Set Business
- How to Send Money from a Western Union Branch
- How to start flower planting business
- How To Deactivate Facebook Dating: Tips for Privacy and Safety
- 18 Tips Exploring the Lucrative World of Travel Ultrasound Tech: Salary, Opportunities, and More
- 18 Tips to Become HR Business Partner
- 24 Ways on How to take your Entertainment Business to Facebook
- 25 Tips to Use 401k to Pay off Debt in Nigeria
- 19 Tips Mastering the Art of Marketing Your Shopify Store: A Comprehensive Guide
- 20 Tips to Open Lubrication Oil Retail Shop
- Top 4 Entrepreneurial Business Lessons
- 17 Tips to Promote Fashion Designing Business
- 12 Tips on How to Open Sport Accessories Store
- 23 Best Promotique for Hair Stylist
- 15 Best Transformative Role of House Cleaning Jobs: Beyond Tidiness
- 19 Ways on How to Start Dental Hygiene Business
- 50 Hair Design Ideas To Inspire You
- 33 Best Art and Science of Window Cleaning: A Clearer Perspective
- 15 Ways on How Profitable is Coconut Business
- The Best Human Hair Headband Wigs: Enhancing Style and Convenience
- 18 Tips to Open Bagel Business Center
- 17 Best Style, Quality, and Affordability Target Men’s Clothing
- How to Register Tanker Trucking Company(24tips)
- How to Make Money Reselling Gas Cylinder
- 15 Tips Savouring the Finest Cuts: Exploring the Best Meat Shop Near You
- 24 Best Ways on How to Get the Best of Bulletproof Toyota Tundra
- Home Economics: Promoting Academic Excellence
- What To Expect When You Manage Your Health?
- 17 Fastest Ways to Speak Spanish
- 5 Tips to Follow the Best SEO Company Primelis
- 13 Top International Realities on Small Business
- 18 Tips Opening an Exotic Pet Shop
- Top 19 Business Doing Guide
- Top 33 Aerospace Engineer Business Activities
- 37 Tips to Start Domestic Shipping Business
- 32 Tips to Trace Tactical Arbitrage Sites
- 28 Best ways to Satisfy a Woman