What Questions Should You Get Answered to Verify a Patient’s Health Insurance Benefits?

Insurance verification is a crucial step for all practices that accept health insurance. It is important to verify the patient’s health insurance plan coverage to ensure that you get paid by insurance. This process ensures that you know whether the services will be covered by the patient’s insurance or needs to be paid by the patient. Below are some questions you want to get the answers to in order to ensure your practice gets paid for the services you provide.

1.What are the patient’s demographic and insurance information? (name, date of birth, insurance provider, member ID)

2. Who is the policy holder?

3. What is the policy start date?

4. What is the policy termination date?

5. What type of policy is this?

6. What is the network status of the provider?

7. Does this plan have an individual deductible?

8. Has the patient met this plan’s Individual deductible?

9. Remaining, spent, total individual deductible

10. Is this service type under Medicare Part A or Medicare Part B?

11. Does the patient have a current episode of home health?

12. Does this plan have a Family deductible?

13. Has the patient met this plan’s Family deductible?

14. Does this plan have an Individual out of pocket maximum?

15. Has the patient met this plan’s Individual out of pocket maximum?

16. Remaining, spent, total individual out of pocket maximum

17. Does this plan have a Family out of pocket maximum?

18. Has the patient met this plan’s Family out of pocket maximum?

19. Remaining, spent, total Family out of pocket maximum

20. Does this plan have a visit limit?

21. Total visits used? Remaining visits?

22. What is the visit limit combined with?

23. Any modality limits per day?

24. Does this plan require authorization? If yes, how do you submit authorization?

25. Does this plan require medical necessity review (MNR)?

26. Does this plan require clinical submission?

27. Does this plan require a referral?

28. Does this plan require a prescription?

30. What is the patient’s responsibility for this upcoming visit?

31. What copay/coinsurance is the patient responsible for in this plan for this upcoming visit?

Want help verifying your patients’ health insurance benefits? One Body can help!