How to Verify Health Insurance

There may be several reasons why you would need to check health insurance. It can be a medical provider that verifies the insurance of a patient or a patient that verifies that its insurance covers what it should. Follow these steps to verify primary and secondary health insurance.

Verification of health insurance as a health care provider (Method 1)

1. Maintain accurate records

Make sure the patient information is up to date.

  • The basic information that you must have in the registry is the name of the patient and the date of birth, the name of the person who is the main insured (usually the name of the mother or the father if your patient is a child), the number of social security, the name and contact information of the insurance provider, and the identification of the patient’s insurance and group number.
  • If you do not have the information required by the insurance company, and if this information is not correct, you may not be able to verify the patient’s insurance.
  • Many factors related to insurance coverage can change in a short period of time. Things like the birth or adoption of a child, marriage, divorce can affect coverage.

2. Ask the patient for the photo identification and the original health insurance card

Make copies to be placed in the paper file or scan for electronic filing.

3. Contact the insurance provider through a telephone or computer system to confirm patient coverage.

On the back of the insurance card there is a toll-free number, along with other information relevant to the health insurance company.

4. Find out if the patient will be covered or not on the date of service.

If your patient has an appointment in the future, it is important to clarify whether or not your insurance will be valid on that date. You can verify this with the insurance company.

5. Clarify benefit options with the insurance company.

Your patient may have a co-payment and certain services that are covered and others that are not. Clarify this with the insurance company.
If there are certain services your patient requires that are not covered by your insurance, make sure the patient understands this.

6. Check if the patient is out of the network.

This refers to whether you are a health care provider, an in-network health care provider, or an 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 the services you provide.

7. Find out how much the patient’s deductible is

A deductible refers to a fixed amount of health care costs that a patient must pay before the insurance begins to pay. The amount varies, so be sure to check this amount with the provider.

  • Also be sure to check if the amount has already been reached from other visits (perhaps with other doctors).

8. Obtain the co-payment

verification Collect any co-payments owed to the patient and send him a receipt. The receipt should describe the services provided and the costs so that the patient can verify 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 items you are not sure about, especially if the insurance is new to the patient.

10. Ask the patient if he has secondary insurance

The verification of the secondary insurance would include the same steps that were mentioned for the primary insurance. Verify the specific percentages or quantities covered by the secondary provider.

Verification of your own health insurance (Method 2)

1. Maintain detailed records of medical care

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 file cabinet, or you can maintain a digital record, for example, on an Excel sheet. In any case, you must have detailed information that includes the amounts paid, the purpose of the visit, surgeries, preventive care (such as dental cleaning), etc.

  • If there is a lack of information, you can request it from your doctor.

2. Keep your health insurance provider informed of any life event

Certain life events can affect your coverage. Therefore, it is important to keep them updated about certain events (for example, if you get married, have a baby, adopt a child). If the insurance does not have accurate records, and then finds out that you did not inform them, they can refuse to pay for your medical care. You may also end up paying more than you need.

3. Carefully read the information you received from your health insurance provider

When you enrolled in your health insurance plan, you probably received a packet of information describing your plan, what it covers, what it does not cover, how much is your deductible, etc. Read this carefully to understand the details of your coverage.

4. Make an appointment with a representative of your insurance provider

If there is something you do not understand or want to clarify, schedule an appointment with a representative. In this way, the representative will have enough time to explain, clarify and answer any questions you have about your coverage.

5. Call your insurance company

Before scheduling important procedures, it is a good idea to call your provider. Make sure 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 will not have unpleasant surprises once you have completed the procedure.