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Insurance Verification Trigger Form
Kevin McNamee, D.C., L.Ac.

The Insurance Verification form is used to trigger your questions with the insurance company representative when verifying your patient’s coverage.  This is done as soon as possible so you and the patient know which financial sources are available for payment. 

If you have the opportunity to verify coverage prior to the patient coming into the office, the better it is for everyone.  Therefore, as a patient calls to make an appointment, ask for the insurance information while you explain that your office verifies coverage for the patient.  Say that your office does this as a courtesy to our patients.

Depending on the type of jurisdiction of your patient’s situation -- Health Insurance, Personal Injury or Workers Compensation, this form is to be completed.

How to Complete the Insurance Verification Form:

  • Complete the top left portion as to the type of jurisdiction – W/C for workers’ compensation, P/I for personal Injury or Health for health insurance.  

  • After you call the insurance company and make your way through the maze of options you will speak with a customer service representative.  Use the form to que or trigger your questions.  Save your brain units for more important things like patient care.

  • The customer service representative comes on – your next line is, “I am calling to verify coverage for the patient “John Jones” member identification number is 123-45-6789.  At this point the representative will usually go through some type of disclaimer like “This is a verification of coverage and not a guarantee of payment.  Payment is based on medical necessity and will be determined at the time your bills are received. What type of coverage are you calling about?”  

  • You should say the specialty and then let the customer service representative do the talking.  Complete the sections on your verification form.  Any questions unanswered you should ask like: What is the billing address?  Has the deductible been met?  If not how much has been met?  Any exclusions or non-covered services? etc.  Be sure to ask the name of the person you spoke with and date.

Which Sections to Complete?

Depending on the jurisdiction there may be several areas to collect.  For example: in a work injury, the workers’ compensation insurance company is the primary payment source but if the work injury is denied, the health insurance may be billed.  If the patient is in an auto accident, usually the automobile medical pay is primary and the health insurance becomes secondary. (Note: Some auto insurance coverage like Mercury or Geico, may be secondary and require the health insurance be billed first then the auto insurance will pick up the balance.)  Therefore, if you have a Health Insurance situation, only complete the health insurance section of the form.  If you have a personal injury situation, call both the Auto Insurance and the Health Insurance. If you have a work injury complete the Worker’s Compensation and Health Insurance section.  If the patient was injured at work related to an auto accident, complete the sections on all three. 

The verification of coverage will help clarify the payment sources for your services.  Except for work injuries, the patient is ultimately responsible for your bill.  

 

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