We understand. The clinical load is heavy. Your days are filled with people who rely on your presence and your care. When the session ends, there’s still documentation, calls, treatment plans… and somewhere in that pile sits your other administrative tasks.
Regular insurance eligibility checks are often one of the first tasks to get skipped. But here’s the thing: clinicians who make this a regular habit tend to run into fewer billing issues and avoid future headaches. We see it time and time again. A few minutes now can save hours of frustration later.
What Is an Insurance Eligibility Check?
An eligibility check ensures you’re authorized to bill for your services, and that your client won’t be surprised with unexpected costs. It also ensures:
- The policy is still in effect
- The plan covers outpatient behavioral health services
- You are in-network or authorized to provide services
- There are no recent changes to deductibles, co-pays, or coverage
Checking eligibility is not just a one-time task. We all know that eligibility can change at any time and for many reasons—clients switch jobs, policies renew, coverage lapses. That’s why monthly or per-visit checks are the best defense against avoidable billing issues.
How Do Eligibility Checks Help Me?
Skipping eligibility checks might save you time now, but it often leads to bigger problems later. Here are the benefits:
- Prevent denials and recoupments: Insurance carriers can (and do) deny claims if the client wasn’t eligible at the time of service. Even if the service was clinically necessary and perfectly coded, you may be left without payment.
- Get paid on time: Delays in verifying eligibility often lead to delayed payments, or worse, rejections that need re-submission. Regular checks keep cash flow steadier and more predictable.
- Protect your practice from liability: In some third-party contracts, including our contract with affiliates, it is the responsibility of the clinician to verify coverage. Not doing so could put your agreement or your income at risk.
- Reduce admin stress: It’s easier to address eligibility before a visit than to chase down claims, appeal denials, or have uncomfortable conversations with clients about unpaid balances.
Tips to Make Eligibility Checks Quick & Easy
You don’t need to spend hours on this. Here’s how to make it quick and effective:
- Set a monthly calendar reminder: Block 15–30 minutes on your calendar each month to run eligibility checks for all your active clients in one go. Treat it like any other essential part of practice management.
- Call the provider line (when in doubt): If online systems are unclear or your EHR doesn’t sync directly with insurers, a quick call to the provider number on the back of the client’s insurance card can save you hours!
- Keep insurance details updated in your EHR: Accurate policy numbers, group numbers, and client data make verification go faster. During intake especially, prioritize clean data entry.
- Create a “coverage check” script: Develop a standard script for new clients and re-verification to make the conversation quick and comfortable.
- Inform clients: At intake and during ongoing care, gently remind clients that it’s their responsibility to notify you of changes to their insurance.
Staying on top of eligibility is important to good practice management. It shows respect for your work, your time, and your clients by ensuring you get paid for the services you provide while minimizing surprises or disruptions in care.
