Insurance verification form
Insurance verification forms might not be most therapists’ favorite use of their time at work, but it is one of the most necessary.
If you’re a therapist such as a mental health therapist, speech language pathologist, occupational therapist or physical therapist seeing clients privately, you’ll need a system in place for gathering accurate, up-to-date information on what services their insurance plan covers.
It can help you avoid denials, maximize payment for services, and improve your clients’ satisfaction. A crucial part of the process is the insurance verification form.
What is an insurance verification form?
An insurance verification form is a document used by a healthcare provider for the purpose of verifying a client’s medical coverage and insurance.
The form typically asks for information such as the following:
- Client information (name, DOB, address, phone number, social security number)
- Insurance information
- Policy holder’s information
- Insurance company/plan name
- Phone number and contact information for insurance company (found on the back of the policy holder’s insurance card)
- Group number
- ID number
- Policy holder’s relationship to the client
- Secondary insurance information (if applicable)
- Anticipated CPT billing code(s) for services
- ICD-10 CM Diagnosis code(s), if any apply.
- Insurance plan coverage information
- Deducible (amount and whether it’s been met or not)
- If the plan includes any out of network benefits
- If a referral is required prior to services
- Whether prior authorization is required
Therapists can create an insurance verification form, download a template online, or use one that’s already been created through a comprehensive practice management software.
When it comes to verifying a client’s insurance, the earlier you get started, the better.
That way, both you and the client know exactly what services will be covered and what (if anything) will be owed.
It’s best to ask a client to provide their insurance information at the time that they first contact you about therapy.
You’ll give the client the insurance verification form to complete. Next, it’s time to submit the form to the client’s insurance provider.
The insurance company will verify the client’s coverage, and complete the portions of the form that detail the benefits for the services you’re inquiring about.
After that, the insurance provider will return the insurance verification form back to you. Based on the information the insurance provider completes on the insurance verification form, you and the client will then know the details surrounding their coverage for therapy.
Then you have the green light to schedule their appointments (pending any preauthorization or referrals that might be required).
Ways to verify insurance benefits
There are actually a few different ways that you can verify a client’s insurance benefits.
1. Call the insurance provider. On the back of the policy holder’s insurance card, you’ll find a contact phone number. You can call this number and speak to a representative who can give you details about the client’s coverage for therapy services (after you provide some required information about the policy holder).
A possible issue with this method of verifying a client’s insurance benefits is that it can be very time consuming. You can end up spending a good amount of time waiting on hold, getting transferred to the appropriate representative, etc.
2. Do an online search. Most insurance companies’ websites have a verification of benefits page. If you have the policy holder’s information (such as social security number, participant ID, and date of birth), you can verify the client’s benefits.
When using this method, it’s important to be aware that you won’t know exactly what information is required until you locate and visit the insurance provider’s website. That could mean some extra time spent back and forth communicating with the client or policy holder to obtain the information you need.
There might also be a question of whether the information you find is the most up to date, and therefore may not be accurate.
3. Use an electronic insurance verification form. Quite possibly the easiest and least time consuming method for verifying a client’s insurance is using an electronic insurance verification form.
This digital solution may be integrated into a practice management software which can even automatically populate the client’s information. With the click of a button, you can verify a client’s insurance benefits for therapy services.
In the world of insurance, one thing that’s constant is change.
Because it’s possible that a client’s insurance plan or benefits can change, most healthcare providers choose to verify insurance monthly. That’s another reason why a quick and simple option like using an electronic insurance verification form can be the best option.
Potential pitfalls with insurance verification forms
If there’s one thing that’s a priority when it comes to verifying a client’s insurance, it’s accuracy.
You want to avoid incorrect or inaccurate verification of insurance that can lead to several potential issues that include:
- Claim denials
- Reduced client satisfaction due to issues like unexpected co-pays
- A lag in reimbursement timing
- Holds on therapy sessions while issues are sorted out
- Negative implications for your practice’s reputation and client-provider relationship
Do’s and don’ts
When choosing a method and verifying a client’s insurance, make sure to avoid these mistakes:
- Typos when inputting required information
- Leaving out mandatory information
- Using information from an expired policy
- Verifying insurance after services have already been provided
- Not verifying insurance in a timely manner
Follow best practices for insurance verification to keep everything running smoothly and accurately, and of course to make sure you are reimbursed on time for services.
Keep these “Do’s” in mind:
- Streamline your system for insurance verification.
- Use a method that will check for errors before you submit for verification.
- Submit insurance verification forms early, before you schedule a client.
- Ask your client the right questions (“Do you have your insurance card?”, “Is this the most up-to-date information?”)
- Communicate possible issues with coverage with the client
(Most insurance companies will give a disclaimer that there are no guarantees in coverage. Sometimes the client won’t know the exact coverage details until after the claim is submitted.)
TheraPlatform is a fully integrated EMR, practice management and teletherapy all-in-one softwar for therapists that helps streamline billing and reduce insurance denials through simple, effective insurance verification. Therapists that use TheraPlatform have the ability to electronically verify a client's insurance. They also offer a 30-day free trial with no credit card required. Cancel anytime.
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