Verifying Aetna + Humana
Purpose
To verify a patient’s eligibility and chiropractic benefits for Aetna or Humana insurance, including deductible, out-of-pocket, coinsurance, and copayment details, and to save a PDF copy for the patient record.
When
Use this process when a patient has Aetna or Humana insurance and the office needs to confirm active coverage and chiropractic benefit details before the visit or before discussing financial responsibility.
Who
This process should be completed by the front desk, insurance verification coordinator, or other designated team member responsible for benefit verification.
User ID: hstriad
Password: changes every 3 months, check password book located at reception desk
Procedure
1. Log in
Log into the insurance verification portal.
Purpose: To access the patient’s eligibility and benefits information.
2. Open Eligibility + Benefits Inquiry
Go to Eligibility + Benefits Inquiry.
Purpose: This section is used to check the patient’s active coverage and plan benefits.
3. Select the payer
In the Payer field, select the patient’s insurance:
- Aetna, or
- Humana
Purpose: Ensures the inquiry is sent to the correct insurance carrier.
4. Select a provider
Choose Select a Provider and pick the appropriate provider option.
Purpose: Connects the eligibility request to the correct treating provider or office.
5. Enter patient information
Scroll down to Patient Information and enter all required patient details.
Purpose: Identifies the correct member record for the benefit check.
6. Submit the inquiry
Click Submit.
Purpose: Sends the request and loads the patient’s eligibility and benefit details.
Coverage Review
7. Open Coverage and Benefits
After the inquiry loads, go to Coverage and Benefits.
Purpose: This section shows the patient’s financial responsibility and benefit structure.
8. Review deductible, out-of-pocket, and coinsurance
Acknowledge and review the following:
- Deductible amount
- Out-of-pocket amount
- Co-insurance
Important note:
- Once the out-of-pocket maximum is met, the patient is covered at 100%
Purpose: Helps determine what the patient may owe and when insurance begins paying in full.
9. Check chiropractic copayment
On the left-hand side, go to: Chiropractic > Co-Payment
Review whether a chiropractic copay is listed.
Purpose: Confirms whether the patient has a fixed copay for chiropractic services.
10. If no copayment is listed
If there is not an option for Co-Payment, then select Co-Insurance.
Interpretation:
- If only co-insurance appears, this usually means the deductible applies to chiropractic services
Purpose: Identifies when the patient’s chiropractic visits are subject to deductible and coinsurance instead of a copay.
Printing and Saving
11. Go to Print
Select Print.
Purpose: Creates a record of the verified benefits.
12. Select Chiropractic
Choose Chiropractic as the section to print.
Purpose: Prints the benefit details specific to chiropractic coverage.
13. Print and save as PDF
Click Print.
The document will generate as a PDF.
Save the PDF to:
- Desktop, or
- designated patient benefits/verification folder
Purpose: Keeps a copy of the insurance verification for documentation and future reference.
Documentation Notes
Be sure the saved PDF clearly shows:
- Insurance payer
- Deductible
- Out-of-pocket amount
- Coinsurance
- Chiropractic copay, if applicable
- Whether deductible applies to chiropractic
Purpose: Provides proof of benefits reviewed and supports patient financial discussions.