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Insurance Verification Policy for LIFE Wellness and Counseling Services
Purpose
To ensure that clients' insurance information is accurately recorded and verified before the commencement of mental health services, guaranteeing smooth billing and payment processes.
Procedure
1.
Initial Contact
1. Client Intake: During the initial contact, whether by phone or in-person, clients are informed about the need to complete an insurance verification form.
2. Distribution of Forms: Provide clients with the insurance verification form via email, in person, or through an online portal.
2.
Completing the Form
1. Personal Information: Clients must fill out their full name, date of birth, address, phone number, and email.
2. Insurance Information: The form must include:
- Insurance company name
- Insurance company phone number
- Policyholder's name (if different from the client)
- Policy number
- Group number (if applicable)
- Relationship to policyholder (if applicable)
- Any secondary insurance information
3.
Submission of Forms
1. Timely Submission: Clients are required to submit the completed insurance verification form at least 48 hours before their first appointment.
2. Method of Submission: Forms can be submitted via email, fax, or in person at the office.
4.
Verification Process
1. Verification Officer: A designated staff member will handle all insurance verifications.
2. Contacting Insurance Providers: The verification officer will contact the insurance provider to verify:
- Active status of the insurance
- Coverage details for mental health services
- Co-payments, deductibles, and out-of-pocket maximums
- Pre-authorization requirements
3. Recording Information: Verified information will be recorded in the client's file.
5.
Communication with Clients
1. Confirmation of Coverage: Clients will be notified of their insurance coverage details, including any co-payments or out-of-pocket expenses they may incur.
2. Issues with Verification: If there are issues with the verification, such as inactive insurance or lack of coverage, clients will be informed immediately to discuss alternative payment options.
6.
Pre-Authorization
1. Required Pre-Authorizations: If pre-authorization is required, the verification officer will assist the client in obtaining the necessary approvals from their insurance provider.
2. Documentation: Ensure all pre-authorization documentation is recorded in the client’s file.
7.
Confidentiality
1. Privacy: All client information will be handled in accordance with HIPAA regulations to protect their privacy and confidentiality.
2. Secure Storage: Insurance forms and related documents will be securely stored to prevent unauthorized access.
8.
Ongoing Verification
1. Regular Updates: Clients will be asked to update their insurance information annually or whenever there is a change in their insurance policy.
2. Re-verification: Insurance information will be re-verified periodically to ensure ongoing coverage.
9.
Handling Denials and Appeals
1. Denial Management: If an insurance claim is denied, the verification officer will work with the client to understand the reason for denial and assist in the appeals process if applicable.
2. Client Responsibility: Clients are ultimately responsible for any services not covered by their insurance.
10.
Billing
1. Accurate Billing: Ensure that billing is done according to the verified insurance information to avoid discrepancies.
2. Client Invoices: Clients will receive detailed invoices reflecting the services provided and the amounts covered by their insurance if their insurance has lapsed and payment is due upon receipt.