Insurance Verification (Healthcare) Policy

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Screenshot of the first page of Insurance Verification Policy

This sample policy outlines a set of policies and procedures to ensure patient benefits are verified prior to or immediately following an admission or outpatient procedure. This document discusses topics such as insurance verification, insurance authorization for planned procedure, and uninsured patients.

Under this policy, personnel performing insurance verification should contact the payer to verify the following items: active and eligible status; plan type; worker’s compensation; out-of-network benefits eligibility; overall benefits; deductible; co-payment; estimated patient liability; out-of-pocket maximum; lifetime maximum; policy limitations or exclusions; and authorization for scheduled procedure or inpatient stay.

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