Insurance Coverage Verification

Many patients don't completely understand their benefits. Asking a patient to confirm their chiropractic coverage can be risky.

Posted in Insurance on Friday, July 15, 2016

Patients often report information received from the carrier as they hear it, not necessarily as a skilled third-party biller would.

This section will help you understand what's involved in verifying the different types of patient insurance coverage and how to establish procedures for your practice.

Verification procedures

Establish a verification procedure for your practice that will ensure you have accurate information. And to assist your staff members with the process, use an Insurance Verification Form for each patient.  A sample form can be found here.

Since your practice is subject to HIPAA regulations, this form can be incorporated into the packet of forms and disclosures for a new patient on the first office visit. Otherwise, this form and the procedures for using it should be part of your practice procedures manual, and a copy of the completed form should be kept in each patient's billing file.

Group Insurance Verification:

• Make a copy of the patient's insurance card for the file.
• Call the verification number on the card to confirm benefits.
• Confirm the address to mail claims.
• Complete the insurance verification form.

Managed Care Insurance Verification:

• Make a copy of the patient's insurance card for the file.
• Call the verification number on the card or use any web verification process provided by the managed care network to confirm benefits and any referral/precertification requirements.
• Confirm the address to mail claims or the process for electronic filing.
• Complete the insurance verification form.

Auto/Personal Injury Insurance Verification:

• Request that the patient bring a copy of the accident/police report for their billing file.
• Request that the patient bring a copy of their insurance policy declaration page.
• If the patient is represented by counsel, obtain the attorney's name, address, and phone number.
• If applicable, send a lien to the attorney.
• Complete the insurance verification form.

Note: Personal injury protection benefits vary in each state. Check with your state Department of Insurance for coverage guidelines. Visit www.usa.gov.

Workers’ Compensation Insurance Verification:

• Request that the patient bring notice of the injury filed with their employer.
• Call the employer to verify that the accident has been reported.
• Request the name/number of the employer's workers' compensation insurance company.
• Call the insurance company or go online and complete an insurance verification form.

Note: Workers' compensation benefits vary by state. Check with your state Department of Insurance for coverage guidelines. Visit www.usa.gov.

Medicare/Medicaid Verification:

• Make a copy of the patient's Medicare card for the file.
• Call the verification number on the card to confirm benefits.
• Confirm the address to mail claims.
• Complete the insurance verification form.