When a prospective patient calls to make an appointment, take time to discuss payment and insurance coverage with them. Provide new patient paperwork prior to or at the first appointment. This paperwork should include a form designed specifically to collect insurance information, as well as a statement regarding payment responsibility. Explain the payment options you offer and require the patient to verify who is responsible for their bill, aside from any insurance they have. You can direct patients to your website where the forms can be accessed.
In order to confirm insurance eligibility, your insurance information form should ask for the following:
•Patient’s name and date of birth.
•Name of the primary insured.
•Social security number of primary insured.
•Insurance carrier.
•Photo ID and ID number.
•Group number.
•Contact information for the insurance company, including phone number, website, and address for submitting claims.
•Any secondary insurance.
Once you have the insurance information, you should contact the insurance company to verify the following information:
•Patient is covered by the insurance.
•Insurance coverage effective dates.
•In-network or out-of-network coverage.
•Services you are seeing the patient for are covered. Do they need pre-authorization and/or a referral by a primary care physician?
•Amount of copay for services, if any.
•Deductible amount. Has the deductible been met for the year?
When the patient arrives for their appointment, copy their photo ID and their insurance card, and collect any applicable copay.
Returning Patients
Keep your returning patients’ records up-to-date. Personal information, like address, contact information, and insurance coverage can change over time, so always have your patients verify their personal information each time they visit your office. If a returning patient indicates a change in insurance, follow the procedure to verify their benefits prior to providing care.