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The ultimate guide to insurance eligibility verification

Verifying client insurance can feel difficult and overcomplicated. Our guide empowers you to streamline the insurance eligibility verification process.

Billing insurance enables you to expand your client base while also making therapy more accessible for people who need it — but, as you may already know, working with insurance companies can often be frustrating. 

Take insurance eligibility, for example. While it’s essential to verify that your client is covered by insurance and understand their specific benefits before conducting therapy, this can also be a time-consuming, stressful process to navigate. 

Knowing the ins and outs of how to verify insurance eligibility can save you time and stress, ensuring you’re able to provide excellent care to your clients. Below, find everything you need to know about insurance eligibility verification.

In this article:

1. Why is it so important to verify insurance eligibility? 

2. What are the benefits of verifying insurance eligibility? 

3. What information do you need to verify eligibility? 

4. How do you verify insurance eligibility and benefits?

5. Become a Headway provider and never worry about insurance verification again.

Why is it important to verify insurance eligibility?

If you accept insurance as a mental health provider, verifying insurance eligibility is an important responsibility. Along with determining if a client is eligible and covered by an insurance payer and plan, you’ll want to clarify exactly what is covered by the payer in the client’s plan. For example, while talk therapy may be covered in a particular plan, certain services or procedures may not be. There may also be limitations to how frequently you can see a client for therapy.

Want to learn more about why insurance eligibility verification is so important as a mental health provider? Check out our dedicated article on the topic.

What are the benefits of verifying insurance eligibility?

The process of verifying insurance eligibility, or ensuring the client’s insurance plan is active and covers your mental health services, can definitely take some time — but it’s ultimately beneficial to both mental health providers and their clients. 

Insurance verification benefits for clients

Verifying insurance minimizes unexpected costs for mental health care and, if needed, gives your client the opportunity to find a more affordable, in-network provider. Knowing what to expect — from copays and deductibles to session limits — can also prevent financial stress for clients while building trust that supports a healthy therapeutic relationship between you and your client.

Insurance verification benefits for providers

Verifying insurance before seeing a client can help prevent denied claims, which ensures you’re paid for the services you provide in a timely manner. Knowing what’s covered by your client’s insurance plan can also help you create a treatment that makes sense for your client’s diagnosis while also preventing unwanted expenses for them in the process. 

What information do you need to verify eligibility?

Before you can verify their insurance eligibility, you’ll need some basic information from your client, including: 

  • Client’s full name
  • Client’s date of birth
  • Copy of the client and the policyholder’s ID
  • Copy of the client’s insurance card


If you’re verifying that a specific service or procedure is covered, you may need additional information, such as: 

  • Relevant CPT codes
  • Relevant ICD-10 codes
  • Session length and frequency 

Certain services and procedures may require prior authorization, so in addition to verifying eligibility and coverage, it’s important to understand whether you’ll need prior approval for these modalities.

Ways to verify insurance eligibility and benefits

There are a few ways you can verify insurance eligibility and benefits before seeing a client. Here are some of the most common ways to do it, along with the pros and cons of each one.

1. Become a Headway provider and offload insurance verification.

Headway handles insurance verification for its providers, along with credentialing and billing. Without the burden of administrative tasks like these, you can focus on the important work of supporting your clients in therapy.

2. Input information into insurance companies’ provider portals.

Some insurance companies have portals where providers can input their clients’ information to verify their eligibility. Start by searching for “member services” or “provider portal” on the payer site. While verifying your clients’ insurance is an important step, it can be time consuming to navigate each payer website and input client information to confirm eligibility. 

3. Call the payer.

You can also call the insurance company to verify your clients’ eligibility. While all insurance companies can provide this information over the phone, you may face frustrating wait times in the process, as you’ll likely face an automated system before talking to a human. Be sure to have all the necessary information ready when you make the call. 

Become a Headway provider and never worry about insurance verification again.

In addition to managing insurance credentialing, billing, and payment, Headway handles the potentially headache-inducing process of insurance verification for all of its providers. Ready to reduce stress in your practice? Learn more about joining Headway today.

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