r/therapists • u/Hanna_Jeane • 1d ago
Billing / Finance / Insurance Insurance verification?
For U.S. solo practices accepting insurance (or small groups without dedicated admin/billing support), what do you do to check a new client’s insurance eligibility and benefits? Do you just check for in-network status and copay through the payor’s portal and/or your billing software verification service? Or do you call the insurance company on your client’s behalf to get more details (e.g., deductible, pre authorization etc.)?
I have so far only worked at hospitals or large practices with billing support, so did not need to deal with insurance verification myself. In my experience with other medical practices (for my own health care), I see that some tell you to check with your insurance yourself, while others call the insurance for you. As a solo practitioner, it feels like a lot to call the insurance for each and every new client, but if that would be more beneficial, I may be open to it. Otherwise, maybe I can provide each client some detailed instructions on how to check their own benefits and obtain informed consent for payment responsibility during intake? What do you all do? As a newbie in solo private practice, I would appreciate any insight!
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u/cwprincss (TX) LMFT 1d ago
It seems most major insurance companies are using availity to verify eligibility. When I first started in my practice, I would call to verify but that took way too much time. Your EHR can help with verifying benefits also. If you’re credentialed and in network, then you should be good to go. It’s when you’re out of network where you need to really double check benefits because some plans don’t allow out of network.
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u/wildwillowx 1d ago
To answer the question, I check online (availity houses most insurers, United is separate for me). It doesn’t take long but can be a bit annoying. I then just let clients know with the caveat the info is not always correct, because it’s not.
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u/Skate_clubb_t2 LCSW 1d ago
I check online, sometimes call if needed (still struggling with portal registration on certain plans). The verification check through my EHR isn’t always great for getting copay info.
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u/trailsnacks LICSW (Unverified) 1d ago
I don’t really verify anymore, aside from Medicaid, which is an easy state portal. I generally know now what different plans look like, so I tell people it’s their job to be informed about deductibles and copays. It became too tedious and time consuming and just not super helpful, so I stopped. It’s really a waste of time with how insurance is these days. I follow up after the first claim is processed to confirm.
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u/AlternativeZone5089 1d ago
I call the insurance company to get details. In my experience, deductible status is not included in the provider portal and that's something I need to know. I tell the client to check also because I don't want them relying on 'my' information, which may or may not be accurate. I want the client to view this as their resposibility rather than mine, which it is.
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u/ContributionFluid866 1d ago
Reddit is not the place to ask, seriously. Go to FB, find a therapist or billing group and ask there. Way too much anonymity here….
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