Checking your insurance coverage before a medical appointment means confirming, ahead of the visit, that your health plan covers that specific provider, at that location, for that service, and roughly what you will pay. A few minutes on the phone or in your plan’s app can save you a bill you did not see coming.
Coverage surprises are common. In a 2023 KFF survey of consumer experiences with health insurance, 18% of insured adults said their plan paid nothing for care they thought was covered. Another 16% said their plan denied or delayed prior approval for care in the past year.
You are not the only one checking. The 2025 CAQH Index, which tracks administrative transactions between providers and health plans, places eligibility and benefit verification at the very start of the workflow, when the appointment is scheduled. In a busy office that job competes with phones and a full waiting room, so many practices give it to dedicated staff, hired in house or added through managed remote teams such as myMedCrew, whose pre-vetted specialists work inside the practice’s own systems. Your own check catches what theirs can miss, and the steps below show how.
What Should You Check Before the Visit?
- In-network status for this provider, at this location. A doctor can be in network at one office and out of network at another. In the same KFF survey, 14% of insured adults said a doctor or hospital they needed was not covered.
- Prior authorization or a referral. Some plans must approve tests, procedures or imaging in advance. HMO plans often need a referral before you see a specialist.
- How much of your deductible you have met. Your deductible is what you pay before the plan shares costs. For workers whose plan has one, the average single-coverage deductible is $1,955 in 2026 (KFF Employer Health Benefits Survey). Early in the plan year, you may pay the full allowed amount.
- Copay or coinsurance. A copay is a flat amount, such as $30 a visit. Coinsurance is a percentage, such as 20%, usually charged after the deductible.
- Your out-of-pocket maximum. This is the most you pay in a plan year for covered in-network care. After that, the plan pays 100% of covered services. Premiums do not count.
- Frequency limits. Plans may cover one physical a year or a set number of physical therapy visits. Check how many you have used.
- Telehealth coverage. For a video or phone visit, confirm the plan covers it with this provider and at what cost share.
Where Can You Find the Answers?
Start with your plan’s member portal or app. Most show deductible progress, a provider search and your Summary of Benefits and Coverage, which lists copays, coinsurance and limits.
Then call the member services number on the back of your insurance card. Write down the representative’s name, the date and the call reference number in case the plan later says something different. Online directories go out of date, so confirm network status with the practice too.
What Should You Ask the Front Desk?
When you book, ask the practice:
- “Are you in network with my exact plan at this location?”
- “Does this need prior authorization, and has it been approved?”
- “Will a lab, radiologist or anesthesiologist bill me separately, and are they in network?”
- “Can you estimate what I will owe?”
No Insurance or Paying Yourself? Ask for a Good Faith Estimate
If you are uninsured or not using your insurance, the No Surprises Act entitles you to a written good faith estimate of expected charges. Under the federal rule (45 CFR 149.610), if you schedule at least 3 business days ahead, the provider must send it within 1 business day. If you schedule at least 10 business days ahead, or simply ask for one, it is due within 3 business days.
Keep a copy. If the final bill is at least $400 over the estimate, you can use the federal patient-provider dispute resolution process (45 CFR 149.620). Your request must be postmarked within 120 calendar days of the first bill.
What If Something Is Denied?
If a prior authorization is denied, ask the practice whether it can resubmit with more clinical detail, and whether your plan covers an alternative. Rescheduling usually beats paying full price.
If a claim is denied later, find the reason on your Explanation of Benefits and call the practice’s billing office. Many denials are data or coding errors it can correct. If not, file an internal appeal with your plan, then request an external review. KFF found only 40% of insured adults know they have a legal right to appeal to a government agency or independent medical expert.
The Short Version
Confirm network status for the provider and location. Ask about prior authorization and referrals, and check your deductible and limits in the member portal. Paying yourself? Get a good faith estimate in writing.