5 Questions to Ask for Medical Insurance Eligibility Verification

When it comes to insurance eligibility verification, it is a comprehensive process and demands fetching accurate information about the patient in order to succeed at it all at once. Also, patient eligibility verification is pivotal to ascertain that denials due to any incorrect or missed information about the patient is under control. There can be a plethora of reasons for claim rejections, and therefore, to avoid any denial, insurance verification in medical billing should be done efficiently to improve the overall billing experience. 

So, if you want to prevent denials and increase your clean claim rate, read on to discover the top five questions to ask for medical insurance eligibility verification: 

“Does the patient have a referral or authorization requirement?”

Well. Knowing whether there is a requirement of a referral or authorization before the patient is seen, is a determining factor to the number of denials you may receive. Also, it is important to keep in mind that denials due to no authorization cannot be billed to the patient because it is not the patient’s responsibility to procure the authorization. 

“What is the patient’s deductible, and if it has been met?”

Having information about the patient’s deductible and verifying its usage helps patients make an informed decision and prepare themselves for the due payment. It will also reduce the number of patient statements you need to send every month, and hence, getting the patient eligibility verification done the right way, leaves no space for denials. 

“Is the patient entitled to any visit limits?” 

It is essential to ask this question during a medical insurance verification because not all insurance plans provide unlimited visits to speciality healthcare services. Further, to reduce the chances of denials due to outnumbered benefits, you should have all information regarding the number of visit limits and how many the patient has already used in a year. 

“Are there any out-of-the-network benefits the patient can avail?” 

Some health plans like HMOs and EPOs do not usually reimburse out-of-the-network providers, which implies that the patient would be responsible for the full amount charged by the healthcare provider if they are not insured with a listed in-house network. This could be a major reason for denial and therefore, finding out this information is important during the medical insurance eligibility verification process. 

“Is the patient eligible for the specific insurance?”

A very basic yet an important question to ask during the patient verification eligibility process as some patients may be unaware of changes in insurance or cancellations in the policy and maybe possessing an old insurance card. So, before scheduling a meeting with a patient, it is necessary to check with the insurance carrier and verify the patient’s eligibility to minimize the chances of denials. 

The Bottom Line:

Asking the right and important questions can not help in reducing denials, but when you execute an insurance verification in an appropriate way, it helps in maximizing your cash flow and keeps patients happy and satisfied.