Insurance Verification: The Conversation Before the Claim

Insurance verification may happen before the patient ever receives a bill, but its impact can continue throughout the entire revenue cycle.

A patient can have active coverage and still have limitations that affect reimbursement.

Benefits may depend on:

• The provider's network status
• The type of service
• Deductible status
• Copayment
• Coinsurance
• Out-of-pocket maximum
• Authorization
• Referral requirements
• Visit limitations
• Specific specialty benefits

Why Details Matter

Knowing that insurance is active is useful. Knowing how the patient's benefits apply to the specific service being provided is much more useful. This is particularly important for specialty services where benefits can vary significantly from general office visits.

Better Information Creates Better Expectations

A thorough verification process can help practices communicate more effectively with patients and identify potential coverage issues before they become claim problems.

The Mave Tech Perspective

Don't wait for the Explanation of Benefits to discover what could have been verified beforehand.