One of the most critical steps of the medical process is confirming insurance eligibility with patients. While you’d like to think that everyone who walks through your office door will be honest, there’s no guarantee that this will be the case, and you need to take steps to protect yourself from people who don’t have coverage for treatment. Here are five ways to confirm patient insurance eligibility that only takes a few minutes of your time.
There are several different ways to verify patient insurance eligibility, but visiting an insurance website is one of the most accurate ways to go about it. Insurance companies have agents available 24/7 to help you with your questions and connect you with a policy that fits your needs. When you need help figuring out how much of a deductible will be covered or whether your plan covers lab services, these agents can walk you through it. They’re there for anyone needing in-depth details on their health plan, and they’re available at any time without waiting around for answers. Visit an insurance company’s website during business hours for a quick chat or send them an email to receive answers whenever is convenient for you.
Clearinghouse is a third-party organization that manages millions of relationships between insurance companies and healthcare providers. When you verify patient insurance eligibility, it is a seamless process for everyone involved. For example, if you need to see a specialist for an unrelated medical condition but aren’t sure whether or not your insurer will cover it (or want to make sure there won’t be a wait before your insurance kicks in), you can ask your primary care physician to submit a pre-authorization request on your behalf. Your doctor will fill out the paperwork with details like what kind of appointment and when you need to be seen.
It may seem obvious, but the easiest way to verify a patient’s insurance eligibility is to call the payer directly. With that being said, you shouldn’t always assume that the customer isn’t going to have insurance and send them a bill they can’t afford. It is your responsibility as a business owner to collect payment at the time of service under your state’s collection laws. Never assume that if a customer says they have insurance coverage, it is true. Do your due diligence and check with their payer(s) before sending an invoice for payment.
If a patient requires a costly procedure, but their insurance only allows for limited coverage of that same procedure, then it’s likely you will end up having to foot part of the bill. When that happens, you need to look at annual limits. Many health plans only cover $2,000 or $3,000 worth of any given treatment per year; after that point, if you want more care in that area or you are trying a new drug therapy or treatment and think it may be helpful in your case, then you might have to pay total price for continued services. Before agreeing to provide a costly service, ask how much their plan covers and whether they have an annual limit.
Asking patients to fill out forms is just one of many ways you can improve your eligibility verification process—the faster you have access to accurate information, the better equipped you are to help patients choose services based on their needs. Online insurance verification gives you more flexibility in collecting important data like coverage levels and contracted providers while also improving your chances of receiving up-to-date information from customers who might otherwise be hard to reach via phone or email.