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Medical Billing Careers

A Direct Cause of Losses. Or a Profit-Builder: Insurance Eligibility Verification

While it is possible to go directly to payer portals and sites, these frequently offer only outdated or inaccurate information. That results in the necessity of a phone call to the payer, which usually leads to getting put on hold. Sometimes for 20 minutes or more. And that lost time can add up across all the patients who have insurance.

There’s also no such thing as a “yes” or “no” eligibility confirmation. Staff has to know the deductible, co-pay, coinsurance, frequency limitations, covered services, plan minimums, and waiting periods of the patient’s plan.

Multiply all that by the number of plans an insurance company has, plus the number of the patients a practice is actively seeing, and it becomes clear why insurance verification so often doesn’t happen.

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