What Is The Verification Of Benefits And Why Are They Important?

by | Aug 21, 2017 | Articles

Billing Solutions Team
Billing Solutions provides medical billing services for behavioral healthcare practices.

You might think that verification of benefits and verification of patient insurance coverage is one in the same, but there are some key differences.

When you go through verification of patient insurance coverage, what you essentially want is the status of the patient or dependent in regards to the policy in question. If they are active with the policy, then that means that the insurance will cover the patient for as long as he or she is paying premiums. In order for a patient’s medical claims to be covered by the insurance company, the patient not only must be active, but the service also must be a benefit that is covered.

When you check the verification of benefits, you are seeing that the patient is covered for certain services, in addition to how much that the insurance companies will pay for these services.

The verification of benefits is considered to be more crucial than the verification of patient insurance coverage, solely because the insurance provider may not pay for the cost of specific services, even if the patient is of active status.

Insurance verifications services are responsible for determining how much money is owed for each type of service used, as well as who is responsible for paying what.

If a doctor utilizes a service that is not covered, the insurance provider will not pay for it; they will leave it to the patient to instead. It does not matter whether or not a patient is active, being a part of an insurance plan does not guarantee that all medical expenses will be covered.

This is important for the insurance verifications service, because they need to explain to the patient how they have to foot their own medical bill and why, in addition to how much they owe, of course. Most patients are do not understand why their insurance will not cover their medical costs, and thus often refuse to pay.

It is crucial that when a patient verifies coverage, that they also verify their benefits, to ensure that what they owe the hospital is going to be covered by the insurance provider. Thankfully, a patient has the chance to verify his or her benefits when he or she verifies his or her insurance coverage.

On the day of the visit, the patients and the physician both need to know on the day of the appointment or visit, which services are covered. If a patient is going to a doctor because he or she is sick, they need verification on benefits involving illness.

Many medical facilities have forms to verify a patient’s benefits, in which a patient can list his or her known services that will be paid for by his or her insurance provider. This will be handy for patients and physicians to know what expenses will be paid for on a patient’s next visit in the foreseeable future, and will be more convenient than asking an insurance provider representative over the phone about what they can cover on the day of the next hospital visit.

Depending on the services performed, the responsibility of the patient’s own expenses may change. For instance, hospitals require a copayment for visits involving illness related inquiries, while copayments are not required for visits involving physical examinations.

Not every insurance policy is the same, and coverage, expenses, and services may vary from patient to patient, so this is why the verification of benefits, in addition to the verification of patient insurance coverage is so crucial before checking in to a medical facility.

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