Should I call the insurance company or use payer portals to verify patients’ health benefits?

There are various ways to verify your patients’ benefits. You can either:

1. Verify benefits via a payer portal (ie Availity)
2. Verify benefits using an electronic verification of benefits (eVOB) software
3. Verify benefits by calling the insurance company
4. Outsource verification of benefits to a third party like One Body

Below we will go through the pros and cons of each process that you can use to verify benefits.

Verify benefits via a payer portal (ie Availity)

Verifying benefits using an online portal is one of the easier ways to verify your patient’s benefits. Unfortunately, there are very few portals that provide all the information you need. Availity is one of the most common portals that aggregates several payers into one portal that you can use for eligibility checks. Availity lacks 2 main key pieces of information: visits used and preauthorization status. These are rarely provided to you and without this information it’s risky to see the patient. If you see the patient and the visit limit has been reached, insurance will not reimburse you. If you see the patient and you get the preauth status wrong, insurance will not reimburse you. 

Another problem with using portals is that you have to know how to interpret them and you need to be knowledgeable about how insurance works. Sifting through pages of health benefits and figuring out what the patient responsibility is is not always straightforward and requires a lot of analysis. 

Verify benefits using an electronic verification of benefits (eVOB) software

Many EMRs today offer eVOB functionality. eVOB is just an integrated solution that uses Availity or other aggregate payer portal but imbeds the search and results into your EMR. While this may save you time in that you don’t have to go to a separate website to check benefits and are able to do so with a click of a button in your EMR, it does not solve for the fact that the same information that is missing from payer portals is also missing from eVOB. 

Both with eVOB and payer portals your front desk staff still finds themselves having to call to get key information that is not included online. Unfortunately while eVOB and portals can give you some information, due to the fact that not all required information is provided, you still have to call.

One of the other issues with portals is that the information is not always up to date. For example with medicare portals, the information regarding visits used, deductible used and even active episodes of home health are not always up to date. Having old information can lead to making errors when doing eligibility checks for patients.

Verify benefits by calling the insurance company

The most accurate way to verify a person’s benefits is to call the insurance company directly. You are able to ask all the questions you want answered. The downside of course are that the wait times, depending on the insurance can be brutal. For Blue Shield, you could be waiting 2 hours just to talk to a rep. The other thing to remember is that you are relying on a representative to tell you the answers to your questions. It’s important to always confirm each thing multiple times with the rep so you are sure that you understand exactly what the patient’s eligibility is.

If you choose to call, make sure you prepare all the questions you want answered in advance and ask the rep each question to confirm the answer multiple times on the call. That way, in case the insurance denies your claim for reasons related to eligibility you can point to the call as evidence as to what the rep told you.

Outsource verification of benefits to a third party like One Body

Many clinics choose to outsource verification of benefits for a variety of reasons. Reason #1: Verifying patient benefits is time consuming. By letting One Body take care of your verifications, you and/or your front desk can focus on other things related to patient experience and patient care. It’s really tough for the front desk to call insurance companies, interpret the benefits, confirm appointments, check people in and do the many other things that they have on their plates. By giving verifications to One Body, it frees up a lot of their time. Reason #2: Verifying benefits is a really important part of getting reimbursed. Many clinics prefer that an expert handle verifications as mistakes or errors can lead to a decrease in reimbursements. If you don’t get a preauth you were supposed to get before seeing a patient or you didn’t know that the patient used up their visit limit, then the insurance may not reimburse you. Reason #3: Outsourcing benefit checks can actually be a cheaper solution and a more predictable cost. When you have your front desk do verifications, if they are on hold for 4 hours, then the cost of that verification is their hourly rate multiplied by 4. With One Body, you pay a fixed rate per verification no matter how many hours it takes us. Reason #4: Outsourcing benefit checks can reduce stress and frustration for you and your staff. Verifying benefits is a tedious and monotonous job that many front desk staff hate doing. They know its important to do them right, yet its the least favorite part of the job. By outsourcing benefits checks to One Body, your staff will be less stressed and less likely to quit. Retention of staff these days is super important.

If you are interested in learning more about how to do verification of benefits, check out our webinar. 

If you’d like to learn more about outsourcing verification checks to One Body, fill out the form below and someone from the team will reach out!