Dynesys® Dynamic Stabilization System - Insurance Verification

Eligibility and Benefits Verification

Understanding and verifying a patient's insurance eligibility and benefits is a critical process prior to treatment. The eligibility and benefits verification process involves the following three steps:

  1. Verifying the patient's insurance eligibility and benefits prior to treatment by contacting the payer's provider line number that appears on the patient's insurance card
  2. Checking with the payer company regarding any patient payment responsibilities including co-payments, deductibles, co-insurance and any other out-of-pocket expenses prior to and post treatment
  3. Informing the patient of their payment responsibilities at the time of appointment scheduling. This step is beneficial to both the patient and the health care provider (HCP). It helps the patient decide on the course of treatment and the HCP to avoid last minute cancellations.

It is important to gather and document information during the insurance verification process for future reference, especially insurer contact information, the patient's financial responsibilities and prior-authorization approval numbers. (See Sample Insurance Verification Form on page 6 and the Insurance Verification Process Flowchart on page 7).

Required Information

Information that should be obtained from the insurer and documented for future reference:

  • Name of insurance representative, including phone number and extension
  • Note date and time of call
  • Patient's health plan effective and/or termination date
  • Type of health plan (HMO, PPO, POS, etc.)
  • Patient's financial responsibilities (i.e. co-payment, deductible, out-of-pocket expenses)
  • In-and out-of network benefits - this information is important to know because if the treating physician is an out-of-network provider and the plan does not allow out-of-network provider services, the patient may have to seek an in-network provider to perform the procedure. Not knowing this information could lead to a claims denial.
  • Verification of benefits for treatment
  • Prior-authorization requirements, if any, including contact information (contact name, telephone, fax number)
  • Referral requirements, if any, including telephone number and fax number to submit a signed and dated referral from the primary care physician or other referring physician

Additional Resources

Sample Insurance Verification Form
Insurance Verification Flowchart

Download Complete Reimbursement Kit PDF

Reimbursement Kit Chapters

Overview
Payer Coverage
Prior Authorization Process
Coding Guidance
Appeals
FAQs
Sample Letters
Disclaimer