How To Verify Medical Insurance Coverage: Medical Insurance Verification Guide

Stethoscope, Laptop And Paper

The medical insurance verification process is one that is well-known to be annoying at best and disastrous at worst. A simple clerical error or missed question can lead to a patient’s coverage being denied. It’s paramount that you get the right information from the patient in order to prevent denials and to maximize reimbursements.

In this article, you’ll learn how to verify medical insurance in a few easy steps while minimizing the risk of missing crucial information.

Steps on How To Do Insurance Verification

Make sure your patient’s information is up to date.

Without up-to-date information, insurance may deny coverage. The best way to make sure information is up to date is to verify a patient’s information with the patient before they come in.

The important information you need is:

  • Full name
  • Date of birth
  • The name of the primary insured
  • Name of the insurance provider
  • Insurance provider’s contact information
  • Insurance ID
  • Group number

There are a lot of reasons why this information may change. A patient may switch employers, get married or divorced, have a child, or switch insurance for any other reason. Also, make sure to request an up-to-date photo ID and the original insurance card. Make a scanned copy or a printed copy and keep it on file.

Contact the insurance company.

It’s recommended to contact the insurance company at least 72 hours before the patient comes to your office. This will reduce the risk of being denied and will allow you to have the information you need.

You should have gotten the payer’s contact info from the patient. If you were unable to do so, you can find this information online on the payer’s website.

Get the necessary benefits information from the insurance company.

Verifying insurance can be like a game of telephone. For this reason, you’re going to want to clarify benefits information with the insurance company directly. You’ll want to get the following information:

  • Confirm the basic information. Patient’s name, policy and group number, the name of the primary, and the relationship of the primary to the patient
  • Whether the patient is covered on the date of service
  • Whether your practice is in or out of network. If you’re out of network, then ask which services are covered.
  • Copay and/or coinsurance information
  • Patient’s deductible
  • Coverage limitations

There could be more information that is necessary to process the claim. Be sure to keep good records of everything in order to help the process go smoothly. If a patient has secondary insurance, then you’ll have to go through these steps with that insurance as well and you’ll also have to confirm how much will be covered by the secondary provider.

Get verification of co-pay and answer questions that the patient may have.

You’ll need to collect a patient’s due co-pay and make sure that they get a receipt. A patient will need this information to verify their own health insurance. Also, answer any questions that the patient has about their insurance, as it pertains to your services. This will make sure that the patient understands what they will need to pay and what insurance will cover.

Read more: What Is Insurance Verification and Eligibility?

Sequence Health offers patient engagement solutions for medical practices of all sizes. Sequence Health is also a provider of medical online marketing services to help increase your patient volumes and grow your brand’s presence.