How to Verify Medical Insurance

Medical insurance verification is a common practice used to protect both the patient and medical practice. By verifying insurance, the physician is able to determine if the patient is covered under the policy and how much his copay and deductible are. Performing medical insurance verification helps prevent the physician and patient from being surprised in the event the provider performs costly procedures and a patient does not have medical coverage that covers them. Also, verifying and sending the claim to the correct mailing address prevents an unnecessary delay in payment from the insurance company.

Instructions

• 1

  Obtain a copy of the insured’s health insurance card if possible. You need the patient’s name, policy holder’s name and date of birth, the policy number and group number to verify health insurance.

• 2

  Call the number on the back of the insurance card listed for provider information. If the only number listed is the customer service line, call that number.

• 3

  Tell the representative who answers the telephone that you need to verify medical coverage. She will ask for your provider number. If you do not have a provider number on file with the insurance company, provide her with the physician’s tax identification number or TIN.

• 4

  Provide the information the representative requests, which may include the provider information and the patient information. She will then supply you with the insurance verification information, such as the policy's effective dates and other information requested pertaining to the coverage available, including deductibles and co-insurance if applicable.

• 5

  Request a faxed or emailed copy of the verification with the claims mailing address listed to place in the patient’s medical chart for future reference.