what are the steps to take when verifying medical insurance & what do you ask-what does it mean?

Answer 1

1) What's the effective date on the policy? >> Its the day the insurance began.
2) What is the plan type & is the doctor/hospital in he patient's network? >> This tells you if the patient will be receiving in or out of network benefits.
3) What's the copay/deductible/co-insurance for the anticipated service? >> It allows the provider & member to have an idea of how much the patient will have to pay & how much remibursement the provider will receive.
4) Is a referral or authorization required for the service? >> It tells you if the patient needs 'permission' from his primary doctor or the insurance company to receive the service in question.
5) What's the claims address & payer ID? >> Tells you where to transmit/mail the claim/bill.
6) Does the patient have any other insurance on file? << Confirms if the insurance is the only carrier or not.

That's the basic format... Depending on the provider type & service being rendered; as well information previously provided by the patient, the questions can vary.

Answer 2

From a provider wanting to verify if the patient HAS insurance? Okay. You call the member services number on the card and follow the Eligibility prompts. You want to know the following:
1. Is the patient active for today?
2. When did they become active on the plan?
3. Is there a copay, how much? (Or does deductible and co-insurance apply?)
4. To what address to do you send your claims to?