Verifying Patient Insurance Coverage

Many treatment agencies are realizing the benefits of working with third-party payers. The collected fees can stabilize income flow, making it easier to provide charity care to a larger population. But even more agencies struggle with this process.

What happens when a client with insurance comes to your agency? Since you probably already gather information from clients at first contact, you can add another question to the process: Do you have insurance? You should ask the next client that says "yes" to bring their insurance card to their first appointment.

The first step of efficient billing is to learn everything you can about that client's coverage. Check the back of the patient's insurance card for contact information. You'll also need to know:

. Primary care physician information

. Total benefits covered

. Calendar year and lifetime max status

. Deductible: any met, and if yes, how much?

. Co-pay for all levels of care

. Claims address

. Certification (pre-authorization) phone number

. Lifetime maximum amount met

. Policy termination date

. Effective date

. Authorizations required

. Name of person you spoke with

These are simple, yet important, first steps in starting a third-party collection system. Does your agency collect from third-party payers? Do you gather all of the information listed above before or during a client's first appointment? Is there any reason why you cannot make this part of your agencies intake process? Please leave your comments, questions and stories below...