What Information Do You Need Before Calling an Insurance Company to Verify Benefits for Physical Therapy - Verification of Benefits powered by One Body
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What Information Do You Need Before Calling an Insurance Company to Verify Benefits for Physical Therapy

Verifying benefits before a patient is seen will allow you to collect the appropriate amount of money from the patient and understand how much of the visit will be covered by insurance. 

To be able to check for benefits you will need a few pieces of information from your patient:

    1.) Patient Name
    2.) Date of birth
    3.) Subscriber ID/Member ID
    4.) Payer name and phone number (This is usually on the back of their insurance card or can easily be found by googling)
    5.) Group ID (not necessary but helpful to collect)

Before checking benefits, you should ask the patient:

    1.) What condition is he/she coming in for? 
    2.) Is your condition related to a car accident or work related injury? If the answer is yes, you will likely not be able to bill commercial insurance.
    3.) Is the insurance card we have on file up to date? 
    4.) If they have Medicare, ask if they are currently receiving home health. If the patient is receiving home health, they will not be able to be seen in office by your clinic so it is important to ask this.

Now that you have all the information you need from the patient, before verifying the benefits, ask the PT for the procedure codes he/she would bill for this patient. Some offices will always use the most common codes for evaluation for a 1st visit.

In addition to the information above, you will need the following information handy:

    1.) NPI – You will want to use the NPI that is registered with the insurance company if you are in network. This may get tricky if you have multiple PTs with various network status’, some using their own NPI and some under the group NPI. It’s best to keep a list of the individual NPIs and the clinic NPI and their network status.
    2.) Tax ID

Now you’re ready to call the insurance company to verify the patients benefits. Depending on the insurance, hold times can range from 15 mins to 4 hours so please make sure you have the allocated time before starting to call. 

If you need help verifying your patients’ benefits, One Body can help! Clinics just like yours outsource verification of benefits to us so they don’t have to wait on hold or deal with interpreting the information given by payers. One Body does that for you. We provide you with a comprehensive, easy to understand benefits report so you know everything about the patient’s responsibility and the payer’s reimbursement requirements before seeing the patient. Fill out the contact form below or email us at hello@onebodywellness.com for more information!

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