Revenue Cycle Management Blog | GroupOne Health Source

Verifying Patient Coverage in a Health Insurance Marketplace Plan

Written by Kaitlyn Houseman | December 31, 2013

The New Year and the new Health Insurance Marketplace, also known as Health Insurance Exchange, is here.  Over a million people will have a new insurance plan and in many cases their first insurance plan in years.  Some may have signed up a few months ago while others just a few days.  While some patients visiting your office will be aware of the need to carry their card with them, some won't and others may have not even received their card in the mail yet.  It is likely that your office will need to verify their coverage.

How do you verify their coverage?

If the marketplace in your state is run by the Federal government, it is best to call their plan's customer service line, a list of all plans and their customer service nubers can be found in this data base. Here's a fact sheet for using the data base.  You may want to print this fact sheet and have it available to your staff. If you can't find the number, call the Marketplace Call Center (1-800-318-2596).

If your state has its own health insurance exchange, contact your state.  To find the website for your state exchange, select the name of yuor state in the box at the left hand side of the website.

How else can you help your patient?

Remind your patients to keep all of their paperwork and receipts from all of their doctor's appointments and from the pharmacy as well.  They may need them for their insurer.  Remind them they should carry their card at all times.  If they don't have a card, they can contact their plan to get a card.

If the patient is uninsured, they have until March 31st to sign up for non-employer based coverage.  They can go to HealthCare.gove to sign up for a plan and apply for financial assistance.  The vast majority of uninsured will qualify for financial assistance to reduce their costs.  You can also download copies of fact sheets or educational material for your patients.


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