Ambulatory Coding & Payment Report
Reader Questions: Eligibility Verification Not Fail-Safe
Question: Our facility provided services to a patient after we verified her insurance eligibility, but the insurance company claims the patient is not covered. The employer group didn't pay the patient's premium, but the insurance company didn't have this information when we checked, probably because their rolls weren't up-to-date. Regardless, we're not getting paid. What should I do to make sure the hospital sees payment?
Washington, D.C., Subscriber
Washington, D.C., Subscriber
Answer: Unfortunately, eligibility verification is not always a guarantee of coverage, no matter how thorough your inquiry. If you aren't satisfied that your call to the insurer will translate into coverage, ask the representative to provide you with an approval number or written documentation of coverage. This strategy gives you leverage to appeal if the insurer denies the claim. If all else fails, though, you may just need to seek payment from the guarantor.
- Published on 2003-06-01
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