What must be verified before the appointment?

• A. The patient's eligibility and contract with the insurance company.
• B. The patient's medical history.
• C. The physician's availability.
• D. The hospital's accreditation.

Answer: (A)

Verifying patient insurance eligibility and the contract details with the insurer before the appointment is essential because it confirms whether the visit will be covered and what the patient will owe. This step includes checking active enrollment, benefit limits, network status, any required referrals or preauthorizations, and copays or deductibles. Knowing this upfront helps the clinic schedule appropriately, collect estimated patient responsibility, and avoid claim denials or unexpected charges after the visit.

Medical history is important for patient care, but it doesn’t determine payer coverage for a scheduled visit. Physician availability affects timing of the appointment, not whether insurance will pay. Hospital accreditation relates to facility quality and regulatory compliance, not to the payer’s coverage for a single appointment.