How to Verify Health Insurance

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There are any number of reasons why health insurance must be verified. Most providers, such as doctors and dentists, want to ensure that they will be compensated for services rendered. Some university programs verify health insurance before allowing students to participate in overseas programs. Regardless of the reasons for the verification, it is important to realize that insurance coverage is not indefinite. A patient might have changed jobs since you last verified his insurance. Even if the patient's health provider remains the same, member and group identification numbers will have changed.

  • Develop a recording system that organizes relevant information. For example, you could create a spreadsheet file with separate sheets for each week or month. Key facts should include the patient's name, insurance company, identification number, effective date, deductible, copay amount, and who you spoke with at the insurance company to verify the information.

  • Request original health insurance cards and personal identification rather than accepting copies. Although the health insurance coverage might be valid, some people commit fraud by using insurance provided to a sibling or relative. Requesting valid photo identification can help you determine if the correct person is utilizing the insurance.

  • Contact the health insurance company directly, usually through a toll-free phone number that is located on the back of the patient's insurance card. Be prepared to wait for several minutes to speak to a live person.

  • Enroll in the insurance company's member or provider system. Many insurance companies verify coverage through an online system designed specifically for health care providers. Instead of calling the insurance company, you could verify coverage by entering patient information online.

  • Evaluate the insurance provider. Scam artists constantly sell fraudulent insurance coverage to unsuspecting people. The fake insurance company even might have a name that is quite similar to that of a major provider.

Tips & Warnings

  • Outsource or hire a third party. Companies such as Care Vault (carevault.com) will verify insurance for you. Thus, you can create greater staff efficiency by not requiring a medical assistant or front office coordinator to spend time contacting insurance companies. Most insurance companies maintain automated telephone systems that allow you to verify insurance during evening or weekend hours.

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