How is health insurance verified at a doctors office / healthcare hospital? How do front office staff verify patients health insurance?
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You have an insurance ID number that they punch into a database and verify and they check the name on that insurance ID against your photo ID. Before you consider trying to use another person’s health insurance be aware that it will end up with your medical records being associated with that other person which might cause them real health issues sometime in the future.
A patient has to give the insurance information which usually includes a card that has all the necessary information on the card. And then the hospital or doctor’s office will either use some sort of online portal that gives them the ability to check whether that information is accurate, or they’ll call the insurance company directly to verify using a special number that is only for that purpose.
They don’t until after the fact. Nothing is verified until it goes to billing. If you provide false information or don’t have the proper issuance they send you a bill.
They start with by asking your health insurance company and then get the policy number which is located on your card. Then they essentially confirm with the health insurance company that you are still active in that specific plan. If confirmed, you will be charged just for the copay, aka the office visit fee. If denied, you’ll have to pay by cash, credit, or check but the health insurance company can reimburse you later if it was a mess up.
Ideally it’s all automated and they just type your number in a system like a United Healthcare card and tells you how much they cover.
Short answer: they don’t, but they can. They don’t really care.
Long answer: Most patients are local to their hospital or doctors office, and the employers/insurance companies local to those areas typically have contractual agreements. If you live and work in NYC, your employer probably offers insurance that will cover care at several, if not all, hospitals in NYC. Those hospitals can take your insurance card and plug the information on it into a portal or website to verify your benefits. Most of their patients have the same 3-4 insurance plans, and the hospital staff is pretty familiar with how to look things up.
But they don’t always do that, especially at first. They will make you sign a waiver when you first go there that says you are liable for any costs not covered by insurance. So… you go see your doctor and you give them your friend’s insurance card. They take a copy of it and add it to your chart, then you go see your doctor and get treated. Your doctor marks down what they did, and a billing system churns out a list of charges that gets sent to the insurance on file. When your friend’s insurance examines and denies your claim, they tell the hospital they won’t pay anything, and the hospital turns around a sends you a bill for the whole visit. They don’t care that you gave them false information because you already said you would pay, and if you don’t they will just sell your debt to their in-house debt collection agency to make their books right.
They take your insurance card and verify the information and confirm that they accept your plan and you pay your copay. Then a few months later you get a huge surprise bill because a doctor who is not covered by your plan happened to be backing his car into a parking spot while your procedure was going on.
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