How to check a patient's health insurance


How to check a patient's health insurance

Insurance verification increases your cash flow, reduces rejected claims, and keeps patients happy. 

- Insurance verification increases your cash flow, reduces rejected claims, and keeps your patients happy.

- An insurance check confirms the patient's coverage and benefits, while an insurance license gives you the green light to provide certain services.

- The insurance verification process involves collecting the patient's insurance information and verifying it with the insurance company.

- This article is for medical practitioners looking to learn the ins and outs of an insurance check.

Let's say you have a great encounter with a patient and feel good that you provided a satisfying experience for the patient. This excitement can come crashing down if you discover that your patient's insurance information is inaccurate and your claims are denied. Checking for appropriate insurance before meeting the patient can avoid this unwanted outcome. The good news is that the verification process is not as difficult as it is often assumed.

What is insurance verification?

Insurance verification is the process of confirming a patient's insurance coverage and benefits prior to an encounter. Most importantly, it is the process of confirming that the patient's insurance plan covers the services you provide and is in your network. If this is not the case, you can either prevent the patient from seeing you or inform them that they will have to pay in full out of pocket for your services.

In some medical practices, the front office staff handles the insurance check. In this case, an insurance check can comprise an amazing part of an employee's workday. If you prefer to ensure that your front office staff has plenty of time to interact with patients, you can outsource insurance verification to third-party medical billing companies. Our reviews of the best medical billing and coding services can help you decide which company is best for you, whether it's the easy-to-use Kareo or the highly customizable AdvancedMD.


You can outsource insurance verification to third-party medical billing companies if processing the process in-house is too difficult.

The importance of checking the patient's health insurance in the medical bills

Insurance verification is equally important whether you have been practicing for a long time or are now opening a medical practice.

Reduces denied claims. Let's say you have a patient's insurance information from last year on file and assume their insurance hasn't changed. If their insurance changes, it is possible that you are sending claims to the fault payer. The result, of course, is an immediate denial of the claim. You will need to contact the patient to determine the appropriate insurance company and resubmit the claim with this motive. However, I have already lost time and money working on this initial claim.

Increases cash flow. Fewer claims denials from insurance verification also improve your cash flow. Think about it: Fewer claims denied means more claims approved, which means more money more quickly. With the right insurance information for all of your patients, you'll go to the right source for compensation the first time.

Increases patient satisfaction. We've all been there: You went to the doctor to get medical attention, but you walked away from paying more than you expected. Shouldn't your insurance cover everything? As a practitioner, you have the power to prevent such unsatisfactory experiences from happening to the patient. Simply check with the patient's insurance before their appointment with you, then tell them what their plan does and doesn't cover. This way, patients don't face any costly surprises.

What is the difference between an insurance declaration and an insurance verification?

Whereas insurance verification is the process of confirming a patient's insurance information, insurance clearance is the process of obtaining approval from the insurance company for certain services. This consent is separate from the medical claims creation and submission process. It is a form of pre-authorization for services and is not retroactive to obtaining payment.

Insurance authorization may be necessary if certain treatments, prescriptions, or tests become necessary for the patient's care. Different payers have different rules about when authorization is required, but their goal is generally the same: to ensure that the payer's money goes toward absolutely necessary, high-quality services.

Some patients may also require an insurance pre-authorization for any and all specialist visits. Often, a primary care physician referral covers this need entirely.

Health insurance verification process

To check a patient's health insurance, follow these steps:

1. Collecting patient insurance information during entry and registration.

When was the last time you saw a patient intake or registration form without an area for the patient’s insurance information? When was the last time you heard an appointment scheduling call during which the patient wasn’t asked for their insurance info? You probably can’t think of the answer to either question or maybe it’s simply never. There’s a reason for that. With a patient’s insurance information immediately available, your verification process starts right away.
Collecting patient insurance information at intake means more than asking the patient which company insures them. It also means getting the patient’s insurance ID, policy number and, if applicable, group number. The patient’s insurance card should also have a phone number that providers can call. You should record this number too.
Additionally, you should check whether the patient or someone else is the policyholder. Make sure to record the policyholder’s full name and relationship to the patient. Group all the insurance information you’ve collected with the patient’s full name and date of birth, and you’ll have everything you need.


Having a complete record of patient demographics offers several key benefits to your medical practice, including faster check-ins, insurance verification and reduced record-keeping labor.

2. Contact the patient's insurance company.

Whether you have an excellent relationship with the patient's insurance company or have never worked with them before, contact them as soon as you have the patient information. You should reach out early, as insurance companies cover a lot of people who may need several days to acknowledge and act on your verification request.

To get started, try to communicate on the phone. Call the number of the insurance provider you collected from the patient and wait for a response from a representative. If you find yourself waiting for what feels like forever, call later, as insurance provider lines are often very busy.

Once you reach the insurance representative, check that the person you are speaking with is authorized to confirm the patient's insurance details. Next, confirm with the representative that your current telephone conversation is a HIPAA-compliant method of transmitting patient information. Next, share the insurance information you collected from the patient. See the next step for tips on doing this effectively.

Alternatively, many insurance companies have online portals where you can enter patient data to check their coverage and benefits. However, these portals are notoriously outdated, so the verification results may be inaccurate. Thus, phone calls are generally best for insurance verification, but online portals can be a convenient option in a jiffy.

3. Ask the right questions.

With the insurance representative on the phone and the patient's insurance information at your fingertips, you're ready to learn the ins and outs of the patient's coverage and benefits. To get started, ask the representative to confirm all of the information you've collected. Then ask if the policy is active and when it expires. Assuming the policy is already active, the insurance company should ask about the patient's participation. You should also collect information on the patient discount.

At this point, you will have confirmed all the basics of your patient's insurance plan, but you shouldn't stop there. You will now need to find out if any type of insurance clearance is necessary before you see the patient. When you inquire about these needs, ask about additional documentation or unusual coverage limits, too. Finally, ask any questions that you know are relevant to the specific motivation from past experience.

4. Start at the top before each patient encounter.

The three steps above comprise the entire insurance verification process. However, patients can theoretically lose insurance or switch plans at any time. It is best to collect the patient's insurance information before each encounter or incentivize them to do so through your practice's patient portal. This idea is true whether you haven't seen the patient in a year or a week.

Don't just ask if the patient's insurance has changed, because this question doesn't tell the patient the date you most recently reported them. Instead, show them all the information you have and ask if it is correct or needs updating. If the information shown to the patient is correct, your insurance verification process is complete. If not, start at the top and don't cut corners. Cash flow, claims rejection rates and patient satisfaction are at stake.
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