Ways to check for patient insurance eligibility

By 

Kevin Yee

Published 

September 14, 2022

Phase Zero helps healthcare organizations digitize their patient onboarding experience to improve patient satisfaction and outcomes.

A patient’s eligibility describes whether their payer & plan covers the services a clinic provides. The provider is responsible for verifying a member’s eligibility before providing care.

Personal Anecdote

Being a startup founder is a ton of fun! One of the few administrative downsides includes providing health insurance for ourselves.

At Phase Zero, we've swapped payers every year since incorporating - which means, every time I visit my PCP or Specialist, I call* to update my insurance information to re-verify my eligibility.

*(More on the phone call in another blog post, but the phone tag between the front desk staff and I could span weeks!)

Ways to check your patient’s insurance eligibility:

The two most common options are

  1. Calling the payer directly
  2. Check for eligibility through the payers' website

Calling the payer directly

The patient’s insurance card usually has the contact number you can use to verify their eligibility. Payers have an interactive voice response system (IVR) that prompts you to say or enter the following:

  • Patient’s Name
  • Insurance member ID
  • Date of Birth

There are options to talk directly with a human but expect long wait times.

Using the payer’s website

Most major payers e.g. BCBS, United Healthcare, and Aetna, provide a provider portal where you can sign up and search for a patient’s eligibility.

The process is straightforward, but if your practice accepts many insurances, having a separate login for each of these payer’s websites could be cumbersome.

A third option: Using software to check for eligibility

Phase Zero provides real-time eligibility checks so that your front desk staff doesn’t have to! 

With Phase Zero’s online forms, a patient can submit their insurance card information and Phase Zero will automatically check whether a patient is eligible in real-time during patient intake.

Using our form builder, providers can create custom workflows and question logic:

For example: If the insurance submitted is ineligible, notify the patient and: 

  1. Provide the option to edit their insurance information
  2. Provide the option to self-pay

all within Phase Zero

Our software was made to integrate into your current tech stack and provide the most seamless patient onboarding experience.

If you want to learn more about Phase Zero’s real-time eligibility checks, schedule a no-obligation demo now.

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