Insurance verification might not be the most exciting part of running a therapy practice, but it’s one of the most critical. Without it, sessions get delayed, denials pile up, and staff spend hours chasing approvals. For many practices, this admin-heavy task creates friction between helping patients and navigating the system.
The good news? With the right approach—and a little automation—you can turn a time-sink into a smooth, reliable process. This guide walks you through what insurance verification actually means, how it works in therapy settings, and what steps you can take to make it faster and easier.
Insurance verification is the process of confirming a patient's insurance coverage before providing services. It ensures that the provider knows:
In therapy practices—like ABA, speech therapy, or occupational therapy—this process is essential for avoiding claim denials and billing errors. It usually happens before the first appointment and may need to be repeated for ongoing treatment or policy changes.
For therapy practices, insurance verification directly impacts both revenue and the patient experience. Here’s why it matters:
In short: no verification, no payment. And for small-to-mid therapy clinics, that’s a deal-breaker.
Whether you handle it manually or use automation, the steps are generally the same. Here's a breakdown of the standard process:
During intake, gather insurance details like the payer name, member ID, group number, and contact info.
This can be done via phone, online portals, or integrated software. You’re looking to confirm coverage and benefits for specific CPT codes or services.
Double-check what services are covered, any restrictions (like age caps or session limits), and financial responsibilities such as copays or coinsurance.
Some therapy services require a prior auth. Skipping this step can lead to denials—even if the service is covered.
Keep a record of the verification call or portal response, including the rep’s name, confirmation number, and coverage notes.
Make sure all staff have access to the latest insurance info before scheduling or billing.
Let’s say you're running a small ABA clinic. Without a dedicated admin team, your therapist ends up spending 30 minutes per patient verifying insurance. That’s 3–5 hours a week of non-billable time.
Now imagine you switch to an automated system that verifies coverage in real time. Instead of phone calls and hold music, you get instant eligibility reports right inside your patient portal. Result? You save hours weekly and reduce denials by catching issues early—before treatment even starts.
Speech therapy clinics also benefit. One practice we studied implemented automated insurance checks and saw a 40% drop in denied claims over 3 months. They also reported fewer patient complaints related to unexpected bills.
Verification confirms a patient’s coverage and benefits, while prior authorization is a formal approval from the insurer required before delivering certain services.
At a minimum, verify insurance at intake and any time the patient’s coverage might have changed—like the start of a new calendar year or after a missed appointment.
Yes, many platforms now offer real-time verification through EDI (electronic data interchange) with payers. This speeds up the process and reduces manual errors.
You risk denied claims, delayed payments, and unhappy patients. It also creates more work later on in appeals and collections.
At minimum: insurance provider, member ID, patient name and DOB, and the specific services you plan to provide.
Insurance verification doesn’t have to be a roadblock. With clear steps and smart tools, therapy practices can handle it efficiently—and get back to what they do best: helping patients. Whether you’re verifying manually or moving toward automation, taking control of this process can save time, reduce errors, and keep your revenue flowing.
