The Insurance Verification Checklist Every Therapy Practice Needs

1. Collect complete intake details

Before any eligibility check, confirm in the patient record:

• Patient legal name exactly as shown on the insurance card, date of birth, and address
• Parent or guardian names and contact information
• Subscriber name, date of birth, and relationship to the patient
• Member ID and group number, plus secondary insurance if any
• Front and back copies of every insurance card
• Referring provider, and whether a referral or prescription is required

2. Verify eligibility for the dates of service

Eligibility answers one question: is the member active on the dates you plan to treat? Confirm the effective date, whether benefits run on a calendar year or policy year, and in-network versus out-of-network status.

3. Capture the minimum benefit set

Benefits tell you how the plan will process therapy and what the patient will likely owe:

• Deductible and out-of-pocket maximum — individual and family, in and out of network, and how much is met
• Copay or coinsurance, and the amounts for each discipline
• Visit limits or dollar caps, whether they are shared across OT, PT, and speech, and visits used year to date
• Whether OT and speech are both paid on the same day
• Habilitative vs. rehabilitative buckets and any required modifiers
• Telehealth coverage and place-of-service rules

4. Check authorization requirements by code

Ask whether authorization is required for the evaluation, for ongoing treatment, and for specific codes such as 97530, 97535, 97112, 92507, 92523, and 92526. Identify requirements before the treatment block begins.

5. Document everything

Record the representative's name, the date, and a call reference number. When a question comes up months later, that record is your protection.