You’re doing it all wrong.
Really, it’s not your fault- no one told you how to do it. The insurance company is not giving seminars or training on how to best receive the allowable benefits for a patient- so how would you know what questions to ask?
We do know how to do it. Mostly it’s because we did it wrong too! We did it wrong long enough to figure it out. We even paid medical billing companies to do the verifications for us- and wow did they do it wrong!! That’s how we ended up taking it in-house- there’s no reason to have them do it poorly, AND pay them for the verification too!
Try to think of the verification as the foundation of your house. If it’s not done properly, there’s always going to be a problem down the line with any number of systems in the house(plumbing, carpentry, roofing, electrical). For billing, it’s the claims, the re-files, the payments and the write-offs that will all be really off, if the verification is not right.
When a verification is not done properly, contracted fees are not allocated properly and claims are delayed or denied. One of the more influential factors in 2023 and 2024 is the notification to a TPA(Third Party Administrator) that a prospective hearing aid patient has an unused ‘discount’ available to them. Note that this is not a funded benefit to the patient, but a ‘discount’. We put ‘discount’ in quotes because we know that this is not a true discount. It’s not the same services that you provide at a lesser fee- It’s really lesser services provided at a lesser fee. Hearing healthcare just doesn’t work that way.
Verifications are SO important that we include them at no additional charge with our claims and submission services. Verifications MUST be done correctly to ensure proper coding, claims submission and billing. It also has a huge effect on your staff and their use of time. Let them answer the phones, and take care of patients- NOT spend an hour on an insurance company’s phone tree!