ACA Blog

Oct 07, 2013

Why verifying benefits is crucial for all clinicians and practices.

Billing is one of the least enjoyable aspects of any provider’s relationship with managed care. It can easily lead to frustration, and denied claims often result in thousands of dollars of lost revenue.

This usually happens because clients unintentionally give inaccurate information about their insurance benefits. Even inevitable clerical errors, such as recording an ID number incorrectly, can delay payment or end up costing several sessions worth of income.

Some insurance companies even “carve out” mental health benefits to other companies, which is something few clients are aware of. This means that the insurance company has outsourced the client’s benefits to another insurer.

For example, Independence Blue Cross (a licensee of Blue Cross Blue Shield) carves out their mental health coverage to Magellan. The end result of this is that a clinician can see a client who has BCBS insurance, submit the claim and then be rejected because the provider is not in network with Magellan. The provider has no recourse then but to write off the loss or bill the client for their out-of-pocket rate.

Both options are unappealing.

There is a simple way to avoid this type of situation: verify the client’s benefits before they come to their first session. This involves collecting the client’s member information and then calling the insurance company to get the member’s benefits.

Verifying benefits can be pitched as a benefit of your services to the client, since you are confirming that they will be covered. This can be comforting to individuals who are already nervous about coming to counseling.

One of the most important reasons for verifying benefits is weeding out clients who will have to pay more than they thought and cannot afford the full amount. A common example is a client who thinks they have a copay of $20.00, but actually owes $100.00 per session because of a deductible.

If you have already seen the client several times at $20.00, they already owe you $160.00! Trying to get that after rendering service is extraordinarily hard, and some clients will simply not return or pay.

Make no mistake, verifying benefits is a boring and repetitive task. An additional downside is that it’s sometimes difficult, and sometimes not possible, to verify insurance outside of normal business hours. This should not dissuade you from getting the benefits checked. It’s a task that has to be done, but it can be accomplished by someone with minimal familiarity with billing.

Working with insurance companies is a great way to bring extra clients and revenue into a practice, and as the clinician, you are ultimately responsible for ensuring that sessions are covered by a client’s plan. Verifying benefits is an easy way to make sure that you will get paid for the services you provide and resolve the majority of financial problems before a client arrives at their first session. 

This article was primarily researched by one of our lead credentialing specialists, Benjamin Baynton, at Thriveworks Counseling.
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Anthony Centore is a Counselor, is Private Practice Consultant for the ACA, and helps counseling practices across the US thrive. For more information on private practice and insurance panels go to http://thriveworks.com

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