At A Glance
Health insurance discovery solutions help hospitals prevent missed billing opportunities, reduce denials and maximize revenue. Learn how coverage discovery works to find missing or forgotten active insurance at every step of the patient’s financial journey.
Key takeaways:
- The ability to verify active insurance before, during and after care is a common challenge for hospitals.
- When coverage information isn’t up to date, healthcare organizations risk losing revenue to uncompensated care and bad-debt write-offs.
- Changes from the One Big Beautiful Bill Act could leave millions of patients without coverage, further compounding the issue.
- Coverage Discovery® from Experian Health helps providers surface active coverage in real time, leading to more accurate billing and more complete reimbursements.
Over the past two decades, U.S. hospitals have absorbed nearly $745 billion in uncompensated care, according to the American Hospital Association. This burden continues to grow as hospitals struggle to verify patients’ active insurance coverage. The task is made harder by patients frequently changing jobs, relocating, and moving through a fragmented payer system that providers must track and interpret.
The result? Missed billing opportunities, delayed payments, and unnecessary write-offs threaten not only the hospital’s financial stability but also its ability to provide care for its communities.
Now, the One Big Beautiful Bill Act (OBBBA) adds even more pressure on revenue cycle leaders. With sweeping Medicaid cuts and stricter eligibility rules, millions of Americans could lose coverage – and healthcare organizations may face a sharp rise in uncompensated care.
Learn how health insurance discovery solutions, like Experian Health’s Coverage Discovery, help empower providers to take control of the coverage gap – not just react to it.
Why health insurance discovery matters
According to the Center on Budget and Policy Priorities, an estimated 16 million people could lose Medicaid coverage by 2034. These changes shift more financial responsibility to hospitals and patients.
But the impact isn’t just financial. For patients, undetected coverage can lead to surprise bills, postponed treatment, or even collections, all of which erode trust in the healthcare system. Vulnerable populations, particularly those affected by the latest Medicaid changes, are at the greatest risk of falling through the cracks.
In these uncertain times, hospitals remain committed to serving their communities, including those who may not be able to afford to pay. But to do this, they must recover every dollar and reduce bad debt. That means identifying coverage wherever it exists, even when it’s hidden, forgotten or misclassified.
That’s where health insurance discovery comes in. By using solutions like Coverage Discovery, hospitals can quickly identify unknown or forgotten insurance coverage across the entire revenue cycle – before, during, and after care. This proactive approach helps providers bill the correct payer the first time, reducing denials, accelerating reimbursements, and minimizing bad debt.
Now is the time to rethink collections.
This webinar shows how leading health systems are turning collections into a precision discipline using data, automation, and continuous monitoring to protect margins against uncompensated care.
How health insurance discovery works
Traditional insurance eligibility checks only verify coverage. Insurance discovery software, on the other hand, goes deeper – allowing providers to uncover unknown or missing coverage. For example, Coverage Discovery scans commercial, government and third-party payers in real time to uncover primary, secondary and even tertiary coverage that may have been missed or forgotten.
| Here’s a closer look at how Experian Health’s Coverage Discovery solution works: |
| 1. Pre-service coverage checks: Coverage Discovery checks for hidden coverage as soon as a patient schedules, using proprietary databases and historical information. |
| 2. Point-of-care checks: At the time of services, Coverage Discovery uses on-demand insurance scans through eCare NEXT® and HIS/PMS platforms to flag billable and government coverage that might have been missed during pre-service checks. |
| 3. Post-service checks: Patient balances in A/R are scanned for active insurance coverage 30, 60, and 90 days post-service. Accounts with active coverage are reclassified and rebilled appropriately. Coverage Discovery can be used to perform a final scrub scan on patient balances before accounts are sent to collections or written off to charity or bad debt. |
What are the benefits of healthcare coverage discovery?
| Healthcare coverage discovery offers several key benefits to hospitals: |
| 1. Maximizes reimbursement: By identifying primary, secondary, and tertiary coverage (including Medicaid and Medicare), hospitals can collect more of the revenue they’re owed for services performed. |
| 2. Reduces uncompensated care: Coverage discovery helps minimize the amount of patient accounts that end up getting written off to bad debt or charity. |
| 3. Boosts efficiency: Automated self-pay scrubbing reduces the administrative burden on staff, while built-in reporting allows revenue cycle leaders to track performance and financial outcomes. |
Why partner with Experian Health for healthcare coverage discovery
Experian Health’s automated coverage identification solution, Coverage Discovery, helps make reimbursements easier to navigate and reduces the burden on staff – from registration to collections. By surfacing hidden coverage early and often with health insurance discovery, hospitals can protect their financial health while improving the patient experience.
Coverage Discovery identified over $60 billion in insurance coverage across 45+ million unique patient cases in 2024 alone, turning missed opportunities into paid claims.
FAQs
The key provisions of the One Big Beautiful Act include more frequent eligibility reviews (every six months instead of annually); higher out-of-pocket costs (up to $35 per doctor visit); and new limits on state Medicaid funding (including bans on provider taxes).
Health insurance discovery is the process providers use to verify whether a patient has active insurance coverage and to confirm coverage details, such as the payer name and plan type. Providers also use it to uncover forgotten or missing insurance at every stage of the patient financial journey.
Insurance discovery is important because it helps providers identify additional or unknown active plans and determine whether a payer will cover planned services. It also helps providers bill the cost of care to the correct payer. This helps providers maximize reimbursements and reduces the risk of uncompensated care before, during and after providing patient care.
The health insurance discovery process typically involves cross-checking payer databases for missing coverage. Most providers perform coverage discovery when a patient first schedules an appointment, at the time of service and post-service to check for active coverage. If the patient doesn’t have insurance coverage, health insurance discovery can also be used to check for Medicaid eligibility and charity support options.
Health insurance discovery improves the patient experience by providing transparency into their financial responsibility for care costs. Patients know what insurance will cover before receiving treatment, while real-time coverage discovery helps patients understand any changes to their benefits.
Claim errors, such as incorrect payer or coverage information, can lead to delays and denials. However, insurance discovery solutions help reduce denials by allowing providers to submit cleaner claims faster, resulting in a more streamlined claims submission process and quicker reimbursements.
Health insurance discovery supports revenue cycle performance by helping providers uncover missed billing opportunities, minimize delayed payments and reduce unnecessary write-offs – leading to faster, more accurate reimbursements and less risk of uncompensated care.
Learn more about how health insurance discovery helps providers reduce claim denials, improve cash flow and deliver better patient experiences.
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