INSURANCE GUIDANCE
Understanding Benefits Verification Before Services Begin
Benefits verification helps organize plan information before services begin, but it is not a guarantee of coverage or payment.
What benefits verification can clarify
Benefits verification may help identify information such as whether a provider is shown as participating, whether authorization is listed as required, and what deductible, copay, coinsurance, or visit limitations may apply. The information available can vary by plan and can change.
What families should confirm
Families should also contact the member-services number on their insurance card and ask plan-specific questions. Useful topics include:
- Whether the requested service is covered under the specific plan
- Whether a referral or prior authorization is required
- Whether there are deductibles, copays, coinsurance, or visit limits
- Whether coverage differs by service setting
- What happens if the plan or eligibility changes
Information to have ready
If you ask EBC to review insurance information, have the member name, member identification number, plan or group information, and the front and back of the current insurance card available through the secure method EBC provides. EBC may request other information if a payer requires it.
A practical reminder
Verification reflects information available at the time it is checked. The health plan makes final coverage and payment determinations under the member’s policy. Review EBC’s Insurance page, then contact EBC with questions about the next step.