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  • Writer's pictureMuhammad Sair Khan

Why Verification of Benefit Checks Are More Important Than Ever



Out-of-network providers are seeing a steep drop in reimbursement rates for services. Overall, rates have fallen around 20 percent over the last few years, enough to throw off any financial planning.


As an out-of-network provider, you may need to work harder to ensure you are paid correctly for your services. The experts at Datapro Billing recommend collecting payment during the patient’s office visit, rather than billing them later. But in order to collect payment at point-of-contact (POC), you need to make sure that you understand each patient’s insurance policy—and help them understand it, too.

An Efficient Verification of Benefits Process


Verification of Benefits starts before your patient even steps foot through your door. When you schedule a patient for an appointment, you should collect the following information:

  • Correct spelling of first and last name

  • Date of birth

  • Insurance company

  • Insurance policy number

This information allows you to learn about their policy benefits before they arrive, and determine what, if any payment they are responsible for. You should understand their:

  • Co-pay. This is a set amount of money the patient pays for each appointment and the easiest payment to collect at an appointment. Many insurance plans have set co-pays for different services, such as a $10 co-pay to see a primary care physician or a $25 co-pay to see a specialist. Be sure you understand what co-pay they owe for your services and collect it before they leave your office.


  • Co-insurance. If a service isn’t covered by a co-pay, it is likely covered through co-insurance. Remember, co-insurance is not based on your retail charge, but any contracted fee schedule you have with a payor. You will need to calculate what percentage of this fee the patient is responsible for and can collect it in your office.


  • Remaining deductible. Unfortunately, the number of high-deductible plans are growing, which means many patients are responsible for a higher portion of the contracted fee until they have reached their deductible, at which point they may pay lower coinsurance on a service or not pay anything at all. If your patient has paid $2,000 in medical charges already, but have a $5,000 deductible, they likely still have to pay a higher amount until they have paid another $3,000 in health charges.

Patient Education About Charges


Insurance companies are paying less and your patients are responsible for picking up the difference. This means more out-of-pocket costs that they may not be expecting.


Unfortunately, educating patients about their own healthcare plan often falls to the healthcare provider and staff. One way to help prevent surprise bills is to inform patients of the estimated costs of their care before they arrive to your office.


Another way to keep patients informed is to discuss the expectations with them after their appointment, and give them reasonable payment options. For instance, you may offer them a discount if they pay all of their fees upfront at that time. Otherwise, they can opt into a payment plan, paying a portion upfront and the remaining amount over a few months. Collecting credit card information and an authorization to charge their credit card at their office visit can also help you ensure you receive all the payment you are owed.


At Datapro billing, our experts can help you develop policies and practices that help you receive the full payments you are owed. Contact us to discuss your billing policies, staff training, and other services that can improve your billing efficiency and decrease unpaid claims.

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