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It’s safe to say that the majority of patients do not understand their insurance coverage. This means that if a patient’s medical insurance is not verified upon check in, there could be many missed opportunities to secure income and reduce staff time.


Knowing if the patient’s plan is active, and if you are going to get paid for the care you’re providing is crucial. Basic information including co-pay, deductibles, and co-insurance should be seen before the patient.

Although this may seem harsh, it is not just a way to determine if you are going to get paid – it is good customer service.

  • By verifying your patient’s medical insurance first, it opens the opportunity to educate your patient on what their insurance covers – which in turn can potentially open more opportunities for your patient as well.
  • Through the verification of benefits, as well as a mutual understanding of these benefits between doctor and patient, it becomes easier to avoid any claim denials and non-payment of claims that have come from patients assuming the costs are covered.
  • NOT verifying a patient’s medical insurance will often result in billing errors that create payment delays throughout insurance companies.

How Does the Process Work?

There are two levels of validating a patient’s medical insurance and benefits. The first, called Insurance Eligibility, consists of validating the basic information in regards to the patient’s medical insurance. This basic information includes determining if the patient’s insurance is active, as well as if co-pay, deductible, out of pocket level, and co-insurance levels will come into play.

The second level of validating a patient’s medical insurance and benefits is called Insurance Verification. The process of verification is much more extensive than that of eligibility, with a telephone call being placed to the medical insurance company directly in order to obtain the patient’s medical insurance benefits. Astonishingly, this call can last anywhere from 20 to 45 minutes per patient.

Ultimately, this call is validating the same information as the eligibility process, however there is an opportunity to ask questions and dig deeper into what is covered. With a simple errors resulting in claim rejections or denials, this is often necessary.

Making the Process Work Best For You:

As imperative as medical insurance verification is, it is surprising how inefficient this process is. Considering the fact that a 20 to 45 minute phone call has to be conducted in order to reach more in depth insurance information, as well as the fact that this information only pertains to the patient’s immediate needs, why is this information typically not documented?

Especially with the way that technology is progressing in today’s world, it is important to consider a professional service and software program. This has the ability bring your practice face to face with benefits like:

  • Timely approval and authorization
  • Simplified workflow
  • Faster billing cycles
  • Improved staff productivity
  • Reduced operational costs

Most importantly, ensuring easy access to this sort of information, as well as consistency, accuracy, and documentation of information means that the time normally dedicated to verifying your patient’s insurance can be shifted back to your main focus – the patients themselves!

We understand the tremendous impact that the medical insurance verification process can have on your practice’s bottom line. We know that a simple error can leave your practice seeing major setbacks, so we offer solutions and services to help you see the benefits. To learn more, contact us at {phone}, or send us an email: {email}