What To Do If Your Doctor Says Your Insurance Is Inactive

The U.S. is known for how difficult it is to navigate the health care system. Everything from making an appointment with a doctor, submitting a claim or completing a payment for medical services is complicated and leaves room for error and confusion.

One of the more frustrating occurrences is when medical providers have issues verifying your insurance information. There are many stories of people making an appointment for a doctor weeks in advance and then being told minutes before their appointment that their insurance is inactive or could not be verified.

It’s unfortunate to say, but this is an occurrence that happens far more commonly than it should. However, it is something that can often be resolved through your insurance provider if you take the appropriate steps.

In this article, we aim to help you understand what you can do in situations where you’re told your insurance is inactive and how you can navigate this as an ISO member.

Why Do Doctors Have Issues Verifying Insurance?

When you visit a doctor or medical facility, their staff typically checks your insurance eligibility through an electronic database. However, errors can occur for several reasons:

• Delayed updates: Your enrollment might be new, and the provider’s system may not have received the latest information yet. For ISO plans, it typically takes 2-3 business days from the date of purchase for your plan to be reported and show as active in provider’s systems.
• Incorrect details: Something as simple as a misspelled name, outdated ID card, or wrong date of birth can cause an “inactive” result.
• System limitations: There’s several types of systems that providers use to verify insurance information. Sometimes your information may not be reported to the system they specifically use.
• Mistaking your insurance company: Insurance companies tend to have variety of networks and plan offerings, which can cause providers to run your information with an incorrect company/plan name.

These issues don’t necessarily mean there’s an issue with your insurance or that it’s inactive, but can come down to a simple misunderstanding or technical error.

What Should I Do If I'm Told My Insurance Is Inactive?

If this happens during your visit, don’t panic. Instead, take the following steps:

• Provide your insurance ID card: Make sure the doctor’s office is using your most up-to-date insurance ID card so you can ensure they’re inputting the correct information. This is especially important if you recently renewed your coverage or visited this doctor in the past.
• Contact your insurance provider: For ISO members, you should report this information to us so we can help you resolve errors. If the provider continues to have issues, they can always call our claims team Sisco for support at 833-577-2586.
• Avoid paying upfront if possible: Unless it’s an emergency, request that the office hold off billing you until verification is completed. Paying the full amount upfront can cause headaches receiving a reimbursement from the provider in the future.
• Keep documentation: If you have to pay upfront, make sure to request an itemized statement from the provider and keep payment receipts. You’ll need this information to submit a claim for reimbursement.

How to Prevent Insurance Verification Issues

While mistakes can happen, there are steps you can take to minimize the chances:

• Avoid making appointments online – call to make your appointment and offer to email the provider your insurance ID card
• Double check to make sure the ID card you send the provider is the accurate card for your current period of coverage. ISO plans all have specific insurance ID numbers which you can reference to see exactly what dates that specific plan is active for
• Call the provider the day before visiting to ensure they verified your insurance information
• Schedule appointments during the office hours of your insurance so you can call in case you run into an issue
• Double check your personal information (name, date of birth, etc.) when purchasing insurance and make sure this information adds up with a personal form of ID (drivers license, passport, etc.)

Being proactive ensures smoother visits and avoids unnecessary stress when seeking medical care.

For ISO members, please do not hesitate to reach out to us via our “Contact Us” page if you run into any issues. Our team is available to help answer any questions you have about finding doctors, making appointments, and getting your claims processed after your visit.