What is the purpose of insurance verification?

• A. Process used to ensure the service received by the patient is approved and paid for by the insurance company.
• B. Process of auditing clinic expenses after services.
• C. Verifying patient identity only.
• D. Determining which bills are sent monthly.

Answer: (A)

Insurance verification is the process of confirming a patient’s current coverage and what the insurer will pay for a service before it’s performed. It involves checking eligibility and benefits, whether the service requires pre-authorization or a referral, that the provider is in-network, and the patient’s financial responsibilities (like deductible, copay, and coinsurance). The main goal is to ensure the service is approved and paid for by the insurance and to inform the patient of any out-of-pocket costs. This helps prevent claim denials and unexpected charges at the point of care.

Auditing clinic expenses after services is a separate task tied to internal finances. Verifying patient identity is only part of the picture—verification focuses on coverage and payment, not just who the patient is. Determining which bills are sent monthly relates to billing cycles, not confirming insurance coverage prior to service.