How is health insurance verified at a doctors office / healthcare hospital? How do front office staff verify patients health insurance?
In: Other
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.
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