What is the difference between an Insurance Verification and Insurance Authorization?

difference between an Insurance Verification and Insurance Authorization

There are a lot of healthcare-related terms that can be confusing, and “verification” and “authorization” are two of them. When dealing with insurance, it is important to understand the difference between the two. Learning the difference can help ensure that your patients get the care they need on time. This article will explain the difference between the two in detail.

What is Insurance Verification?

Insurance verification is the process of confirming that a patient’s insurance plan will cover the services they are seeking. This usually involves contacting the insurance company directly and asking about the specific coverage. In some cases, insurance verification can be done through an online portal. However, it is important to note that you must know how the health insurance verification process works since not all insurance companies make their information readily available online.

It is important to verify insurance before providing services because it can help avoid billing issues later on. If a patient’s insurance does not cover the services they received, the provider may be stuck with a bill. In some cases, the patient may be responsible for paying the bill if their insurance does not cover it. With the help of insurance verification services companies, the process of pre-authorization, pre-certification, and pre-determination of benefits can be streamlined and help your practice save time.

What is an Insurance Authorization?

An insurance authorization is similar to insurance verification, but it goes a step further. Authorization means that the insurance company has approved the specific services that the patient is seeking. The authorization process often requires more documentation than insurance verification. In some cases, the provider may need to submit a treatment plan or other medical records.

It is important to note that an insurance authorization does not guarantee that the patient will not be responsible for any out-of-pocket costs. The patient’s insurance plan may have a deductible or copayment. In some cases, the service may not be covered by the patient’s insurance at all.

The Key Difference

The key difference between insurance verification and authorization is that insurance verification only confirms that the patient’s insurance will cover the services. In contrast, authorization means that the insurance company has approved the specific services. It’s crucial to distinguish between the two because it may assist ensure that patients receive timely care.

To Sum It Up

With the help of insurance verification and authorization services, you can avoid billing issues and save time. So, if you’re looking for a way to streamline the process, be sure to check out some of the services available.