15 Steps How to Verify Health Insurance

(doylc.com) How to Verify Health Insurance - There can be a variety of reasons why you need to review health insurance. You can be a medical provider verifying insurance for a patient, or a patient verifying that your insurance covers what it should. Use these steps to review primary and secondary health insurance.

• Health insurance check as a service provider

1. Maintain accurate records. Make sure the patient information is up to date.

The basic information you should have on file is the patient's name and date of birth, the name of the person who is the primary insured (usually the mother's or father's name if your patient is a child), the 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 that information is incorrect, you may not be able to verify the patient's insurance.

Many factors that affect insurance cover can change within a short period of time. Things like birth or adoption of a child, marriage, divorce can affect coverage.

2. Have the patient provide you with a photo ID and the original health insurance card. Make copies for paper filing or scan for electronic filing.

3. Contact the insurance provider by phone or computer system to confirm coverage for the patient. A toll-free number is usually noted on the back of the insurance card, together with other relevant contact details for the health insurance company.

4. Find out whether or not the patient is insured on the day of the service. If your patient has an appointment in the future, it is important to clarify whether or not their insurance is valid at that time. You can prove this to the health insurance company.

5. Clarify the benefits with the insurance company. Your patient will likely have a co-payment and may receive certain services that are covered and some that are not. Clarify this with the insurance company.

If your patient needs specific services that are not covered by their insurance, make sure the patient understands this.

6. Check whether the patient is inside or outside the network. This relates to whether you, as a healthcare provider, are an on-network or an off-network healthcare provider. If you are not part of the patient's network, the patient's insurance may not cover all or some of the services you provide.

7. Find out what the patient's deductible is. A deductible refers to a set amount of healthcare costs that a patient must pay before the insurance company begins paying. The amount varies, so be sure to check this amount with the provider.

Also check whether the amount has already been covered by other visits (possibly to other doctors).

8. Have the co-payment confirmed. Collect any co-payments due from the patient and provide them with a receipt. The receipt should show the services rendered and costs so that the patient can prove their own health insurance.

9. Be prepared to respond to patient inquiries about co-payments and coverage. If necessary, contact the insurance provider to verify the points you are unsure about, especially if the patient is new to the insurance company.

10. Ask the patient if they have secondary insurance. The verification of secondary insurance would involve the same steps as mentioned for primary insurance. Check specific percentages or amounts taken by the secondary provider.

• Check your own health insurance

11. Maintain detailed medical records. It is important that you have a record of the treatments you have received and when. You can do this by keeping a file in a filing cabinet, or you can use a digital record, e.g. B. in an Excel spreadsheet. In any case, you should have detailed information about the amounts paid, the purpose of the visit, operations, preventive measures (e.g. teeth cleaning), etc.

If you are missing information, you can request the missing information from your doctor.

12. Inform your health insurance company about all life events. Certain life events can affect your insurance coverage. Therefore, it is important to keep them informed about certain events (e.g. when you get married, have a baby, adopt a child). If the insurance company doesn't have an accurate record and later finds out you didn't tell 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 company carefully. When you signed up for your health insurance plan, you probably received an information pack describing your plan, what it covers, what it doesn't, what your deductible is, etc. Read this carefully so you understand the details of your coverage .

14. Make an appointment with a representative of your health insurance company. If you don't understand something or want clarification, make an appointment with a representative. This gives the representative ample time to explain, clarify and answer any questions you may have about your coverage.

15. Call your insurance. Before planning any major surgery, it's a good idea to call your doctor. Make sure there are no issues with your insurance and that no additional information is required. Find out whether and to what extent the costs of your procedure will be covered. This way you will not experience any nasty surprises after the procedure is completed.