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.
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.
on the type of jurisdiction of your patient’s situation -- Health
Insurance, Personal Injury or Workers Compensation, this form is to be
to Complete the Insurance Verification Form:
the top left portion as to the type of jurisdiction – W/C for
workers’ compensation, P/I for personal Injury or Health for health
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
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?”
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.
Sections to Complete?
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.
verification of coverage will help clarify the payment sources for your
services. Except for work
injuries, the patient is ultimately responsible for your bill.