5 Questions To Ask For Medical Insurance Eligibility Verification

Insurance eligibility verification is one of the most complex processes in the healthcare domain. Given the increased rate of claim denials, one needs to be more and more careful in terms of claim submissions. A denied claim not only upsets the patients but also takes a toll on your revenue cycle. Your reimbursement gets delayed for a long time. Hence, it is important to accomplish patient eligibility verification much before you render your services to your patients.

In this blog, you’ll find the important aspect of insurance that must be considered before you finalize an insurance provider.

Things to consider when considering an insurance provider

1. About the patient benefits:  

Different insurance providers have different policies. Insurance companies list different services under different plans and cover them accordingly. For example, a particular service could not be covered under the medical insurance plan, but could be covered under the vision services plan. It would be a good step to ask your insurance about the patient benefits covered by them.
The reason for the visit mentioned to the scheduler can often get a claim denied for medical insurance, while it gets a pass for vision insurance.

2. Referral from primary care doctor:

Most insurance companies compulsorily ask for a referral from the primary care doctor of the patient to seek services from a specialist. In such cases, if the primary care doctor hasn’t already provided the referral, contact them regarding the same. Also, inform the patient about the amount they’ll be paying on their own since it will be different from what they paid to their previous doctor.

3. Participation of the healthcare provider:

It is a provider’s duty to inform their patients if they are not in contract with the insurance company. The provider must inquire from the insurance company about their plan and its levels of coverage. One must not assume that since their services were covered in the previous plan, the other plans would also function the same way.

4. Out-of-network benefits:

If the provider does not qualify as a participating provider for a specific plan, the insurance company should be asked about the out-of-network benefits they provide as a part of their plan and policy. This information should be provided to the patient before their visit.

5. Deductible payment:

As a part of medical insurance verification, it is crucial to ask the insurance company about the deductible and keep the patient informed about the same. It wouldn’t be a pleasant experience for the patients to arrive on the date of the appointment and be surprised with a bill that they shall be paying on their own. Go through your patient’s insurance plans well in advance to save them from any surprises. This will improve the trust your patients have in you.

Medical insurance eligibility verification is a complicated yet crucial process that determines the smooth running of your revenue cycle and also saves your patients from unnecessary surprises. As a part of the credentialing process, do not forget to ask the insurance provider about the patient benefits they offer, if they will require a referral from the previous primary care doctor, about their out-of-network benefits, and the amount of money that the patient shall be paying on their own.

It can be a real task to manage your patients and their insurance verification side-by-side. Capline Healthcare Management is here at your resort. We take care of all insurance verification in medical billing for all your patients. We take care of everything, from producing error-free bills, to submitting claims, taking follow-ups on the claims, and making sure they are settled. We also keep the patient informed about the share of the bill that will be paid by them.