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Verify client required

i'm going to walk you through the process i use to verify insurance benefits for a new client as a disclaimer this process is not a guarantee of coverage for each client coverage is dependent upon the client's insurance plan when i first schedule a session with a client i verify their insurance policy type if they have an insurance plan that i do not take my first question is whether or not they want an in-network referral some clients do have out-of-network benefits but often the client will need to pay a portion of the services for an of network provider if a client plans to pay out of pocket i do explain all payment policies and procedures if a client is using their insurance i do require that they submit all paperwork so then that way i have everything on file before i verify benefits there are different types of insurance that you want to be aware of they include medicare medicaid and private or commercial insurance not all private or commercial plans have nutrition counseling benefits and some are actually limited by plan type one thing you want to make sure of is whether or not a client has one or two payers responsible often you may see a client who has a primary insurance like medicare and a secondary insurance like highmark you will need to know which insurance is considered primary because that's the insurance company you will need to bill first it is important to note that medicare and medicaid have very specific guidelines for how and when you can bill a client if you do not accept medicare and did not opt out of the network you will need to refer the client to an in-network medicare provider this only pertains to covered services though if you did opt out of medicare you may be able to enter into a private contract with a client for them to self-pay however you need to make sure that you review all medicare guidelines before doing this when you're calling to verify insurance coverage for medical nutrition therapy or mnc you will need to know the member's plan id their date of birth your npi tax id cpt codes and icd-10 codes you may be on hold for an extended period of time so make sure you have all this information ready to go so you don't waste more time once you actually have a representative on the phone you're going to want to ask a few key things when you call the insurance company the first is the benefit period is the policy active and when does it end are referrals needed from a physician for services to be covered if you do need a referral make sure you get that before you render services you will need to keep referrals on file and typically they're only going to be good for the year you also want to ask if there is a limitation on...