How to verify insurance eligibility before patient appointments
The day before each visit, the agent checks coverage and copays, and flags problems while there's still time to call the patient.
- Reach it by
- Phone
- Text
- Who can use it
- Your front desk, billing staff and patients
- Works in
- Your practice management system's schedule report · An eligibility service on your practice's account, such as Stedi or pVerify · Phone and text
The problem
Patients change jobs, plans and payers without telling you. You find out at check-in, or weeks later when payment is denied.
Checking every patient by hand takes hours each day, so it gets skipped on busy days. Those are the visits you end up writing off or billing to a patient who didn't expect it.
What your agent does
- Tomorrow's scheduleYour system's daily schedule report
- Your agent checks each patient's coverageActive plan, copay, deductible and visit limits, electronically
- Clean visits marked readyCopay noted for the front desk
- Problems flaggedInactive plan, out of network or authorization missing
- Patients contactedAsks for a new card or explains what they'll owe
- A morning list for your front deskWho's ready, who's not, and what's still open
What you get
- Every patient checked before they walk in
- Coverage problems found a day early, not at check-in
- Copays known up front, so they're collected at the visit
Who approves what
Checks and reminders to patients run on their own once you set them up. Updating insurance on file, quoting a cost estimate or rescheduling a visit goes to your front desk or billing lead to approve.
Common questions
- Doesn't our practice management system already do this?
- Many run a basic eligibility check. The agent goes further: it reads the details, such as visit limits or a missing authorization, and does something about them, like texting the patient or flagging it for your staff.
- What happens with payers that only answer by phone?
- Those go on the morning list for your staff, so they know which few calls to make. The agent checks the rest electronically, through the eligibility service on your practice's account.
More for medical & dental practices
Prior authorizations
The agent fills the payer's form from the clinical notes, faxes it, tracks every reply and chases denials so procedures don't slip.
Fax referrals
The agent reads each incoming referral fax, preps the patient record, checks coverage, offers the patient times and lets the referring office know.
What job would you hand to an agent?
Book a free 15-minute call. Tell us the job that eats your week and we'll tell you how an agent would handle it and what it would cost.