How to Check Health Insurance Eligibility

Member eligibility is important to the member and the provider of health care services. If the member does not have current eligibility at the time of service, the health insurance plan will not cover the provider's bill. In order to receive payment, providers should check member's eligibility prior to providing services. Member eligibility may change on a monthly basis, so even though a service may have been pre-authorized, if the member is not eligible at the time of the service or doctor's visit, the claim may be denied and the member would be responsible for the bill.

Instructions

• 1

  Call the phone number of the health insurance plan that is on the back of the member's insurance identification card. Tell the representative you want to check the eligibility of the member and provider member information. Many insurers automate this process through an interactive voice response system.

• 2

  Check the member's health insurance eligibility online on the insurer's website. Many larger carriers have separate portals for members and providers to log in and check member eligibility. The user must have the member's name, date of birth and member ID number to complete this check.

• 3

  Call the insurance company's fax recall system and select the option to receive a fax with the member's eligibility information. The fax recall system may not be available for all health insurance carriers. Providers will likely be familiar with the carrier's fax back process if there is one available. Check the member and provider handbooks for information on this process.

• 4

  Look carefully at the member's health insurance ID card as it likely contains the health insurance policy effective date. Providers should not rely on this method alone to check eligibility as the card does not indicate a termination date and the member may have dropped coverage any time after the card issuance.

• 5

  Contact your human resources department to check the effective date of your health insurance, if you a member. Though you may have signed up for insurance at the time of hire, your coverage start date may not be for another 30 to 90 days, depending on the policies of your company. The HR department may also be able to provide a termination date, which is a date in which coverage ended and you are no longer eligible.