How to Verify Health Insurance

Co-authored by Scott Mosser, MD

Last Updated: September 18, 2024 Approved

There may be various reasons why you would have a need to verify health insurance. You may be a medical provider verifying insurance for a patient, or a patient checking to make sure that your insurance is covering what it should. Use these steps to verify primary and secondary health insurance.

Method 1

Method 1 of 2:

Verifying Health Insurance as a Health Care Provider

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1
Maintain accurate records. Make sure that patient information is up-to-date.
- The basic information you should have in the record are patient's name, and date of birth, the name of the person who is the primary insured (commonly the mother’s or father’s name if your patient is a child), social security number, the name and contact information of the insurance provider, and the patient’s insurance ID and group number.^{[1]
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  - If you do not have the information required by the insurance company, and if this information is not accurate, you may not be able to verify the patient’s insurance.
- Many factors regarding insurance coverage can change over a short period of time. Things like birth or adoption of a child, marriage, divorce can affect coverage.
Make copies to place in the paper file or scan for electronic filing.

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A toll-free number is generally noted on the back of the insurance card, along with other relevant contact information for the health insurance company.
If your patient has an appointment in the future, it is important to clarify whether or not his insurance will be valid on that date. You can verify this with the insurance company.^{[2]
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Clarify the benefit options with the insurance company. Your patient will likely have a co-pay and may have certain services which are covered and some that are not. Clarify this with the insurance company.^{[3]
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- If there are certain services your patient requires that are not covered by his insurance, make sure the patient understands this.
This refers to whether you, as a healthcare provider, are an in-network health care provider or out-of-network health care provider. If you are not in the patient’s network, the patient’s insurance may not cover all or any of any services you render.^{[4]
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Find out how much the patient’s deductible is. A deductible refers to a set amount of health care costs that a patient must pay before the insurance will begin to pay. The amount varies, so be sure to verify this amount with the provider.^{[5]
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- Also be sure to verify whether or not the amount has already been met from other visits (perhaps with other doctors).
Collect any co-pay that is due from the patient, and provide them with a receipt. The receipt should outline the services provided and the costs so that the patient can verify their own health insurance.
If necessary, contact the insurance provider to verify those items that you are uncertain of, particularly if insurance is new to the patient.
Verification of secondary insurance would include the same steps as mentioned for primary insurance. Verify specific percentages or amounts covered by the secondary provider.

Method 2

Method 2 of 2:

Verifying Your Own Health Insurance

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1
Maintain detailed health care records. It is important that you have a record of the treatments you received and when. You can do this by keeping a file in a filing cabinet, or you can keep a digital record, for example in an Excel sheet. Either way, you should have detailed information listing amounts paid, purpose of visit, surgeries, preventative care (such as dental cleaning), etc.
- If you are missing information, you can request the missing information from your doctor.
Certain life events may affect your coverage. Therefore, it is important to keep them updated on certain events (e.g if you get married, have a baby, adopt a child). If the insurance does not have accurate records, and later finds out that you failed to inform them, they may refuse to pay for your medical care. You may also end up paying more than you need to.^{[6]
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When you enrolled in your health insurance plan, you probably received a packet of information describing your plan, what it covers, what it doesn’t, how much your deductible is, etc. Read this thoroughly so that you understand the details of your coverage.
If there is anything you do not understand, or want clarification on, schedule an appointment with a representative. This way, the representative will have adequate time to explain, clarify, and answer any questions you have about your coverage.
Before scheduling major procedures, it is a good idea to give your provider a call. Make sure that there are no problems with your insurance and that no additional information is needed. Find out if and how much of the cost of your procedure will be covered. By doing this, you won’t have an ugly surprises once your procedure is completed.

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Tips

Take time to review new policies and procedures submitted to you by health insurance providers. This simple practice can help save hours of time in verifying health insurance.

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Keep all medical receipts and records together in 1 file or folder. This allows easy access when addressing an insurance problem or coverage question.

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Be patient when dealing with insurance providers. Although their methods of calculating invoices may be different than yours, most of the time they are accurate.

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