MedCare Docs
Feature Guide

Insurance Verification

Real-time insurance verification via VAPI with automated policy detail extraction

Overview

The Insurance Verification module uses VAPI (Voice API) technology to automatically call insurance providers and verify patient coverage in real-time. The system extracts policy details, coverage limits, and eligibility information without manual intervention.

Verification Process

  1. 1
    Select Patient:

    Choose a patient from the verification queue and click "Check Insurance"

  2. 2
    VAPI Call Initiated:

    System automatically calls the insurance provider using patient policy information

  3. 3
    Data Extraction:

    AI agent extracts coverage details, deductibles, copays, and authorization requirements

  4. 4
    Results Display:

    Comprehensive coverage summary with visual charts and detailed breakdowns

Coverage Details Extracted

  • Plan Type: PPO, HMO, EPO, or POS designation
  • Network Status: In-network or out-of-network provider status
  • Deductible: Annual deductible amount and current progress
  • Copay Structure: Copay amounts for different service types
  • Coinsurance: Patient responsibility percentage after deductible
  • Out-of-Pocket Maximum: Annual maximum and current progress
  • Prior Authorization: Services requiring pre-approval
  • Covered Services: List of covered procedures and treatments

Visual Components

Coverage Summary Card

High-level overview with plan type, network status, and coverage dates with visual timeline

Deductible Progress Bar

Visual representation of deductible progress showing amount met and remaining

Copay Breakdown Chart

Bar chart showing copay amounts for primary care, specialist, ER, and lab services

Coinsurance Pie Chart

Visual split between patient responsibility and insurance coverage percentage

Out-of-Pocket Circular Progress

Circular gauge showing progress toward annual out-of-pocket maximum

Call Transcript Access

Every verification call is recorded and transcribed. Click the "Transcript" button to view the full conversation between the AI agent and insurance representative. Transcripts are useful for:

  • Audit and compliance purposes
  • Resolving coverage disputes
  • Training and quality assurance
  • Documentation for patient records

Network Status Indicators

In-Network

Provider is in patient's insurance network - lower costs apply

Out-of-Network

Provider is outside network - higher costs and different coverage rules