Making a List, Checking it Twice: Getting Ready to Verify Patient Benefits for 2025

Santa’s not the only one who has to mind a list this time of year; if you work at a practice that accepts insurance, you’re probably already thinking about the painstaking process of verifying patient benefits once you get back to the clinic in the new year.  While we don’t have any of that magic that the big guy uses to travel the globe in one night, we do have some tips on how you can prepare yourself so that your January is less stressful than years past. 

Collect (or verify) all the relevant information. 

If front office staff had a collective wish list, it would undoubtedly include a request that every patient stay with their insurance provider forever and that every plan’s benefits never change. (Although I’m not sure even Santa could make that wish happen.) Today's insurance landscape means that patients are bouncing around insurance plans as often as the calendar turns over. That means staff has to be ready to update patient records with the most up-to-date info to avoid unnecessary denials and delays down the line. 

At a minimum, you should be collecting: 

• Name and date of birth;
• Insurance company (including phone number and address);
• Relationship to the primary insurance plan holder, if not the policyholder; and
• Policy number and group ID number (if applicable).

If you’re looking to take a more proactive approach, you can run reports on the expiration dates for patient policies to find the ones that will clearly need to provide updated information. Getting a head start on this will allow you to reach out to patients who need to provide updated insurance information—avoiding a front desk logjam during the first weeks of the year. There are a number of tools for communicating with patients about updating their insurance cards, from patient portals to emails and digital forms to a good old-fashioned phone call. Speaking of… 

Reach out to insurance companies. 

Any Christmas story needs its Grinch, although comparing insurance companies to the Grinch is harsh on the Grinch. (At least his heart eventually grew, which is more than we can say for UHC, Anthem, and the lot.) Unfortunately, front office staff eventually have to contact various insurance providers to in fact verify all the important information for the coming year:

• Is the patient covered under the policy for therapy visits?
• How many visits are authorized under their plan?
• What’s the patient’s copay and annual deductible?
• What’s the policy on prior authorization?
• What documentation requirements exist for each visit/episode of care? 

Granted, no one wants to spend that much time on the phone in the year 2024, least of all with insurance companies. That’s why we’d recommend electronic benefits verification to trade out the call for a couple of clicks; really, it’s the best gift you could give your front office going into next year.  

However, if you opt not to go that route, many payers offer online portals where you can verify patient benefits; it’ll just take a lot more manual work on the part of staff. Here are just a few examples:

• Aetna
• Blue Cross Blue Shield
• Cigna
• Humana
• United Healthcare

Save that insurance information in your EMR. 

Having just collected countless insurance details from patients and payers alike, you're probably not eager to do it again anytime soon. You can avoid any of that by recording all of those details about the number of visits, copays, deductibles, and documentation right inside their record within your EMR. (Or if you’re using electronic benefits verification, that information will get transferred automatically—just saying.) If a patient has a new insurance card, you can go ahead and scan it when they come in for their first appointment of the year; it’s also a good opportunity to follow up on any outstanding questions or to communicate changes to their benefits or new copays and deductibles if you haven’t already discussed it with them.

Make benefits verification a year-long thing. 

Ever heard of Christmas in July? I don’t get it personally; you’re losing a lot about the holiday when you’re switching out the chill in the air and snow on the ground for a sweltering summer day. But for the purposes of our benefits verification conversation, it’s a pretty good metaphor. 

Instead of leaving benefits verification to the end of the year, why not try and tackle it throughout the year to make December and January a bit less painful? Granted, you might not have the personnel and time to make it a monthly chore, but trying to go through and reverify benefits at the midpoint of the year or, ideally, at a more frequent clip can help you dodge an easily avoidable cause for claim denials.  

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Proactive benefits verification can’t solve all of your reimbursement woes; much of the onus for that falls with insurance companies that make Mr. Potter look downright generous in comparison. But it’s a great start to controlling what you can to make your claims process smoother.