Running a practice
The ultimate insurance verification checklist for therapists
It’s easy to forget the questions you should ask when verifying a client’s insurance. Our insurance verification checklist — and features — make this process easier.
March 28, 2025 • Updated on August 29, 2025
3 min read
If you accept insurance, verifying your clients’ eligibility and benefits is an important responsibility — but it can also be a stressful process. After sitting on the phone waiting for a real human to pick up, you’re tasked with remembering all the right questions to ask, which can feel like a lot of pressure.
Headway takes the stress out of the equation by verifying eligibility on behalf of providers — but we also have a checklist that walks you through all the questions you need to ask. Read on to learn more about how to make verifying eligibility a breeze. Looking for more support? Check out our detailed guide to insurance verification.
Practice in-network with confidence
Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.
Basic information needed
Before you get on the phone with an insurance company, you’ll need to have specific information about your client and their insurance plan, 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 need to verify that a certain service or procedure is covered by your client’s insurance plan, then you may need the following additional information:
- Relevant CPT codes
- Relevant ICD-10 codes
- Session length and frequency
Below, view our checklist as a downloadable PDF.
Questions to ask
Having the right questions prepared can save you time and stress by ensuring you only need to call the insurance payer once to get the information you need. Consider the following questions when you reach out to an insurance company.
Confirm general eligibility and coverage.
- “Can you confirm if the patient’s policy is active and effective as of today?”
- “What is the plan type?” (PPO, HMO, EPO, Medicaid, Medicare, etc.)
- “Who is the payer and administrator?” (Especially for third-party administrators or employer-sponsored plans)
- “What is the effective date and termination date of coverage?”
Ask about the specific service(s) to be verified.
- “Does this plan cover [CPT code] for [service]?” (e.g., 90837 for therapy, 99214 for an E/M visit, etc.)
- “Are there any restrictions or limitations for this service?” (e.g., number of visits per year, prior authorization)
- Limit to the number of visits per year: “How many visits are allowed and how many have been used so far this plan year?”
- Prior authorization required: “What is the prior authorization process?”
Check financial responsibility.
- “What is the patient’s copay for this service?”
- “Has the deductible been met? If not, how much remains?”
- “What is the coinsurance percentage after the deductible is met?”
- “What is the patient’s out-of-pocket maximum?”
- Do co-pays apply to the patient’s out-of-pocket maximum?
Verify provider network status.
- “Is [Provider name & NPI] in-network with this plan?”
- “If out-of-network, what are the patient’s financial responsibilities?”
Confirm telehealth and location-based coverage (if applicable).
- “Does the plan cover telehealth services for [this CPT code]?”
- “Is place of service (POS) 02 or 10 covered for telehealth?”
Check for authorization or pre-certification requirements.
- “Does this service require prior authorization?”
- “If so, how can we submit an authorization request?”
- “How long does authorization approval typically take?”
Get reference information for the call.
- “Can I have a reference number for this call?”
- “What is your name and/or operator ID?”
- “If I have additional questions, is there a direct line I can call?”
Verification made simple
With Headway, therapists can run in-network practices without the hassle of manual insurance checks. We take care of the details, at no cost to you.
This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.
© 2025 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.
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