by John Yodonise

April 26, 2017

Do You Need To Verify Patients

Patient Eligibility and Benefits

The medical insurance landscape is changing and the need to verify patient eligibility and benefits has never been more critical to the financial success of your practice.

It is estimated that the patient's financial responsibility has increased from 10% to 30% since the Affordable Care Act has been enacted.

Failure to verify eligibility and benefits can be very costly and lead to issues when patients receive statements for unpaid copays and deductibles that were not disclosed when they first came to the office for treatment.

One issue that has become critical is secondary insurance. In the past, patients with two insurances had little to no patient responsibility after the claim is processed. But today, many secondary insurances have copays and deductibles that the patient is responsible for when the claim is processed.

When Should You Verify Eligibility and Benefits?

January and July are two of the most critical months to verify your patient's eligibility and benefits. It is always wise to ask patients if their insurance has changed on a regular basis to make sure you have the most up-to-date information available.

The beginning of a new year brings with it changes to your patients’ eligibility and benefits. The beginning of a new year also means that both calendar year deductibles and visit frequency limitations reset.

With open enrollment, patients may be covered by a new insurance company and not realize their benefits have changed. Many times the patient may not know that they now have a copay or deductible due for services provided.

Medicare Insurance Alternatives

One of the biggest issues we have seen involves Medicare insurance alternatives. Patients are being moved from Medicare to third party Medicare alternatives and often they do not know all of the implications of that change.

Many times they don't even realize they have been switched off of Medicare as companies find ways to reduce their expenses for retired workers. So when a patient presents his or her Medicare card, make sure you ask if they have any additional insurance cards.

Don’t get stuck with unnecessary denials or upset patients. Do your due diligence before the patient arrives by obtaining updated insurance information at the time of scheduling and make copies of the insurance card at the time of the visit.

When Do Deductibles Reset?

Remember that deductibles are typically based on the calendar year and will reset on January 1. Best practice is to communicate with patients upon scheduling to remind them that their plan has a deductible that may be resetting on January 1 and, if that is the case, payment will be due at the time of service.

If you offer an appointment reminder service, remind the patient if payment is expected at the time of service. Failure to collect deductibles, copays and coinsurance at the time of service can be very costly for a practice, as your ability to collect can decrease significantly after the patient leaves the office.


Taking these proactive steps to protect your practice by preventing denials, delays in payment and disgruntled patients goes a long way toward ultimately saving time and money.

With the increase of copay amounts and high deductible plans that are becoming the norm, your financial success can depend on how well you verify your patient's eligibility and benefits and collecting what is due at time of service.

{"email":"Email address invalid","url":"Website address invalid","required":"Required field missing"}

Discover Our Latest Posts