When someone in your office says a patient’s insurance has been verified, what does that actually mean? According to the dictionary, to verify is “to check whether or not something is true.” But we need to go much further than that if we want happy patients and good collection numbers. Merely verifying that it’s true that a patient is covered by a particular insurance plan is just the start of insurance verification. If we want to do it right, we also need to verify:
- Insurance maximums, deductibles and amounts already used
- Frequency limitations on all procedures we regularly perform
- Last instance insurance was used for any procedures we regularly perform
- Any exclusions or inside maximums on procedures we may perform
- Any waiting periods for procedures we may perform
- Any age limitations for procedures
- Any missing tooth clauses or waiting periods for re-dos
All of the above should be on a convenient form or spreadsheet that your office can use when calling an insurance company, reviewing an insurance benefits fax, or checking an insurance verification website. It definitely takes a bit more time to fully check insurance, but that time is very well spent when you consider the alternative. Patients have much higher expectations and much less tolerance for unexpected co-pays than ever before. While they agree that it is their insurance and we’re not responsible for what insurance does and doesn’t cover, they will argue the copy, refuse to pay or leave the practice because they feel blindsided with a large co-pay. This is a case where an ounce of verification is much better than a pound of apologies in both patient relations and accounts receivable.
