January Insurance Reset Survival Guide: A Step-by-Step Re-Verification Checklist for Therapists

You verified a client’s insurance back in the spring. They’ve been seeing you every week. Nothing seems to have changed.

Then January rolls around.

The deductible resets. The copay may be different. Your client may have changed plans during open enrollment and forgotten to mention it. And by the time that first January EOB arrives, you may have already seen the client four times.

This is why January can get messy for therapists who bill insurance.

The good news is that you don’t have to spend the first week of January chasing insurance information for your entire caseload. A little preparation in October, November, and December can make January much more manageable.

This guide walks you through a simple re-verification process for existing clients. If you’re verifying insurance for a brand-new client, start with my Insurance Verification Checklist for Therapists.

Quick Answer

For most commercial plans, the deductible and out-of-pocket maximum reset when the new plan year begins. For many plans, that’s January 1. And even when your client’s insurance company hasn’t changed, their benefits may have.

To avoid unnecessary surprises:

1. October: Make a list of your active insurance clients and note each plan’s renewal date.
2. November: Ask clients whether their insurance will change for the new year.
3. December: Collect new insurance cards and verify new-year benefits when the payer makes them available.
4. January: Confirm anything you couldn’t verify earlier and pay close attention to the first claims and EOBs.

The goal isn’t to verify everyone on January 2. The goal is to know where each client stands before you submit claims for the new plan year.

What Is a January Insurance Reset?

An insurance reset is simply the beginning of a new plan year. For many commercial insurance plans, that happens on January 1. When the new plan year begins, several things can change at the same time:

• Deductibles reset. A client who met their deductible during the previous year may be starting over at $0.
• Out-of-pocket maximums reset. A client who had already reached their maximum may begin accumulating toward a new one.
• Copays and coinsurance can change. A $20 copay could become $40, or the client could move to coinsurance instead.
• The client may have a different plan. They could move from a PPO to an HMO, switch to a high-deductible plan, or change plans while staying with the same insurance company.
• Member IDs can change. New cards may be issued even when the payer itself hasn’t changed.
• Network status can be different. Being in-network with an insurance company doesn’t necessarily mean you’re in-network with every plan that company offers.
• Authorization requirements can change. A new plan may require prior authorization, or an existing authorization may no longer carry over.

(Don’t assume every client’s plan resets in January. Some employer-sponsored plans operate on a different plan year, such as July through June. That’s why I recommend tracking the plan renewal date rather than automatically treating January 1 as the reset date for everyone.)

Initial Verification vs. January Re-Verification

These are two different jobs.

	Initial Verification	January Re-Verification
Who	New clients	Existing clients
When	Before the first appointment	Before the first session of the new plan year
Goal	Confirm coverage and benefits	Find out what changed since the last verification
Process	Full insurance verification	Review the existing information and verify the new plan year

A client you verified once isn’t verified forever. When the plan year changes, treat the client’s benefits as something that needs to be confirmed again.

When Should You Start Your January Insurance Reset?

I like starting in October.

That may sound early, but you’re not doing the entire process in October. You’re spreading the work out so you’re not trying to reverify your entire caseload during the first week of January.

Month	Focus	What to Do
Late October	Build your list	Pull your active insurance clients and note each plan’s renewal date.
Late November	Start asking clients	Find out who is changing insurance for the new year.
December 1st	Collect and prepare	Get new cards and verify new-year benefits where available.
January	Confirm and monitor	Finish anything that couldn’t be verified earlier and watch the first claims closely.

One important note about December

Don’t panic if a payer won’t show you next year’s benefits yet. Some insurance portals won’t make the new plan information available until the new plan year actually begins. If that’s the case, document what you were able to verify and put that client on your January follow-up list.

You’ve still done useful work. You may already have the new insurance card, member ID, and plan information in your EHR. You’re just waiting for the payer to release the benefit information.

The January Insurance Re-Verification Checklist

Here are the ten steps I would work through for each active insurance client.

Once your list is built and you have a system in place, most straightforward verifications shouldn’t take very long.

Step 1: Make a List of Every Active Insurance Client

Don’t try to do this from memory.

Pull a client list from your EHR and filter for anyone you’ve billed to insurance recently. Looking at claims from the last 60 days is one practical way to build the list.

For each client, track:

• Client name or ID
• Insurance company and plan name
• Member ID
• Plan renewal date
• Last verification date
• New card received
• January verification status
• Notes

You don’t need an elaborate spreadsheet for this.

A simple table is enough. If your EHR allows custom fields or tags, you could also use something like “January Reverify” so you can pull the list back up when you need it.

The important thing is having one place where you can see who has been verified and who still needs attention.

Step 2: Ask Clients for Updated Insurance Information

Send one short message to your insurance clients in November. I would send a reminder in December to anyone who hasn’t responded and/or following up with them at the end of their next session.

Something as simple as this works:

Hi [Name], we’re doing our yearly insurance update for the new year. If your insurance is changing on January 1, please send a photo of the front and back of your new card before your first January session. If nothing is changing, just reply “no change.” Thank you.

I like including the “no change” option. Otherwise, clients may simply ignore the message because they don’t have a new card. A written “no change” gives you something to document and makes it easier to identify the people who still haven’t responded.

Step 3: Confirm Active Coverage

For each client, confirm:

• The policy is active for the new plan year
• The effective date
• Whether the plan or member ID has changed
• Whether the client is still the subscriber or a covered dependent
• Whether you’re still in-network for that specific plan

Don’t rely on the insurance card alone. The card tells you what information the client has. It doesn’t tell you whether the coverage is currently active.

Step 4: Check the Deductible

This is where January gets interesting.

Check:

• The annual deductible
• How much has been met
• Whether the deductible applies to outpatient mental health services
• When the plan year resets

For many clients, the amount met will be $0 at the beginning of a new plan year. But don’t assume that’s true without checking.

Here’s a common situation:

Your client has been paying a $25 copay all year. In January, their new plan has a $3,000 deductible that applies to outpatient mental health services.

Same therapist. Same appointment. Very different patient responsibility.

If you don’t catch that change until the EOB arrives, you may suddenly have a client with a balance they weren’t expecting.

That’s exactly the kind of surprise you’re trying to prevent with January reverification.

Step 5: Confirm Copay or Coinsurance

Find out exactly how the client’s cost-sharing works.

It could be:

• A flat copay
• Coinsurance based on the allowed amount
• Deductible first, followed by coinsurance
• A copay that applies only after the deductible has been met

Don’t reduce the information to simply “patient has a $30 copay” if that’s not actually how the plan works.

“Deductible applies, then 20% coinsurance” is a very different situation from a straightforward $30 copay.

Make a note of the actual benefit structure so you can explain the estimate accurately to the client.

Step 6: Check the Out-of-Pocket Maximum

Confirm:

• The individual out-of-pocket maximum
• How much has been met
• Whether behavioral health services apply toward the maximum

This can be especially important for clients with high-deductible plans or clients who see you regularly.

Step 7: Check Authorization Requirements

Ask:

• Is prior authorization required for outpatient therapy?
• Is the current authorization still valid in the new plan year?
• Does the new plan year require a new authorization?
• Are there visit limits?
• Did those limits reset?

Don’t assume an existing authorization automatically carries over. Authorization requirements can change when the plan changes, and missing an authorization can create a much bigger billing problem later.

Step 8: Confirm Telehealth Benefits

If you provide therapy by video, check the telehealth requirements for the new plan.

Confirm:

• Telehealth is covered for outpatient mental health
• The appropriate place-of-service code
• Whether a modifier is required
• Any plan-specific restrictions

Depending on the payer and plan, you may be using POS 02 or POS 10, for example. Telehealth rules have changed frequently over the past few years, so I wouldn’t simply copy last year’s setup and assume it’s still correct. Check the current requirements for the specific plan.

Step 9: Document What You Verified

This is one of those billing habits that saves you later.

If you don’t document the verification, you’re relying on your memory when something goes wrong. If you are using an EHR like SimplePractice that allows you to add admin notes to a patient’s profile:

Record:

• Date verified
• Payer
• Verification method — portal, phone, clearinghouse, etc.
• Representative name and call reference number, if applicable
• Effective date
• Deductible and amount met
• Copay or coinsurance
• Out-of-pocket maximum and amount met
• Authorization requirements
• Anything unusual or worth remembering

And remember: insurance verification is not a guarantee of payment. Payers say this for a reason. The information you’re given is based on what the payer can see and report at the time of verification. A claim can still deny later.

Good documentation gives you something to go back to if the claim doesn’t process the way you were told it would.

Step 10: Update Your EHR and Billing System

Don’t stop at the verification call. Update the client’s insurance profile and whatever billing system you’re using.

Update:

• Insurance information
• Member ID
• Copay or coinsurance
• Deductible information
• Authorization details
• Any notes that will matter when the January claims are submitted

Then mark the client as complete on your tracking list. Your verification process should end with your records matching what you found.

The basic workflow is: verify, document, update, communicate, and monitor.

What to Tell Clients When Their Deductible Resets

You don’t have to become your client’s insurance expert. Your job is to tell them what you found and give them a reasonable estimate of what they may owe.

A good message should explain:

• What the insurance company reported
• What their estimated cost per session may be
• That the amount is only an estimate
• That insurance benefits can change
• That the insurance company makes the final determination on each claim and you must legally abide by their determination
• Where they should go with questions about their actual plan

I would send this information before the first January session, rather than waiting until the first statement goes out.

Clients generally handle an unexpected deductible much better when they know about it ahead of time.

Copy-and-Paste Client Script

Hi [Name], happy new year. We checked your insurance benefits for the new plan year. Your plan shows a deductible of $[amount] that started over on January 1. Until that deductible is met, your estimated cost per session is about $[amount]. After that, your cost should be $[copay or coinsurance].

This is an estimate based on the information your insurance company provided. Your final cost will depend on how they process each claim.

If you have questions about your plan or benefits, the number on the back of your insurance card is the best place to start. Let me know if you’d like to talk about payment options.

Adjust the last sentence to match your practice’s policies.

If you don’t offer payment plans or other payment arrangements, don’t imply that you do.

What If a Client’s Insurance Has Changed?

Here are the situations I see most often.

Scenario 1: Same Insurance, New Deductible

Reverify the benefits, update the client’s cost estimate, and let the client know what changed.

This is one of the easiest January changes to deal with when you catch it before the first few claims go out.

Scenario 2: New Insurance Company

Treat it as a new insurance verification. Don’t just change the payer name in the EHR and start submitting claims.

Confirm:

• Eligibility
• Network status
• Benefits
• Deductible
• Copay or coinsurance
• Authorization requirements
• Telehealth requirements

If you’re out-of-network with the new plan, talk with the client about their options before the next session whenever possible.

Scenario 3: The Client Doesn’t Send Updated Information

This is where your written financial policy matters. If you don’t have a policy for situations where a client hasn’t provided current insurance information, January is a good time to create one.

Some practices choose to treat the session as self-pay until current insurance information is provided. Others may verify whether the old card is still active before the appointment.

There’s no single approach that works for every practice. Whatever policy you choose, put it in writing and apply it consistently.

Scenario 4: Insurance Says Something Different From What the Client Expected

This happens frequently with high-deductible plans. Document what the payer told you. Share the information with the client. If the client believes the insurance company is wrong, direct them back to the insurance company.

You don’t have to argue with the client about their benefits, and you don’t need to defend the insurance company. Your job is to report what you verified.

Scenario 5: A January Claim Denies

Don’t automatically assume you made a billing mistake.

Before changing your claim, check the basics:

1. Eligibility — including an old or incorrect member ID
2. Whether the client changed plans
3. Whether the deductible was applied
4. Network status for the new plan
5. Authorization requirements
6. Claim details such as POS, modifier, or CPT code

One important distinction: a claim applying to the deductible isn’t necessarily a denial.

If the payer processes the claim and assigns the allowed amount to the client’s deductible, that is generally patient responsibility. It can look alarming on the EOB, especially when the client was used to a small copay, but it isn’t the same thing as a claim being denied.

If the claim actually denied and you’ve ruled out the common January issues, then it’s time to look more closely at the denial reason.

My guide on How to Appeal an Insurance Denial walks through that process.

Your January Billing Reset

You don’t need to spend an entire weekend getting ready for January. Depending on how many patients you have, block out an afternoon or two during the last week or two of December and use it to figure out where things stand.

First

Pull your insurance client list.

Mark:

• Who sent a new card
• Who said “no change”
• Who hasn’t responded

Next

Look at the clients who have appointments during the first couple of weeks of January. Check their deductibles, copays, coinsurance, and any other benefits that could affect their patient responsibility.

Last

Update your EHR and flag anyone who still needs:

• A payer call
• A client follow-up
• A new insurance card
• Authorization information

You probably won’t finish every client in one afternoon. That’s okay. The point of this exercise is to know who needs attention so nothing gets lost.

If you already use my Monday Billing Routine, you can add the remaining follow-ups to your first couple of January billing sessions.

How to Keep January From Becoming a Billing Fire Drill

Once you’ve gone through this process once, make it part of your annual billing routine.

A few simple changes can make a big difference:

• Put the process on your calendar. Set recurring reminders for October, November, and December.
• Use the same verification template every year. The less you have to remember, the less likely you are to skip something.
• Track the last verification date. If the information is from a previous plan year, it probably needs another look.
• Ask for new insurance cards every year. Make the November request a standard part of your practice workflow.
• Verify with the payer. Don’t rely entirely on what the client remembers about their benefits.
• Watch the first few January claims. If something is wrong, it’s much easier to fix a problem on claim three than on claim thirty.
• Document payer calls. Keep the date, representative name, and reference number.

The goal isn’t to spend more time on billing. It’s to catch changes before they turn into patient balances, denied claims, and uncomfortable conversations with clients.

Need Help With Your January Insurance Reset?

There are a couple of ways to approach this, depending on whether you want to handle the process yourself or have someone help with the workload.

Learn the Process and Get Ongoing Support: Bill Like a Boss

If January reverification is one of the billing tasks you dread every year, Bill Like a Boss is a resource I recommend because I’ve used it myself.

I used the program when I moved from physical therapy billing into mental health billing, and I still go back to it when I need a refresher.

For this particular problem, the useful pieces include:

• The template library
• A weekly live billing meeting with certified billers
• A searchable replay library
• More than 40 trainings and 20+ templates
• Scripts and billing forms
• A private community for therapists who bill insurance

One thing to understand before joining: this is a training and support resource, not a done-for-you billing service. You or someone on your team will still need to do the actual verification work.

If you’re considering it, read my Bill Like a Boss review first. I break down what the membership includes and who may not need it.

Get Bill Like a Boss

Hand It Off: Short-Term Insurance Verification Help

If you don’t want to spend your December working through your insurance list, I also offer short-term insurance verification help for the January reset.

I’ll work through your active client list, reverify benefits, document what I find, and give you a clear list of anything that still needs follow-up.

This can be particularly helpful if you have a busy caseload, a lot of high-deductible plans, or simply don’t want January to start with a pile of insurance work.

Contact me about January insurance verification help

January Insurance Reset Checklist

Use this as your quick-reference list:

• List every active insurance client
• Note each client’s plan renewal date
• Ask clients about insurance changes in November
• Collect new insurance cards in December
• Confirm active coverage and member ID
• Confirm you’re in-network for the specific plan
• Check deductible and amount met
• Check copay or coinsurance
• Check out-of-pocket maximum
• Check authorization requirements and visit limits
• Check telehealth coverage, POS code, and modifier
• Document verification date, method, and reference number
• Update the EHR
• Send clients their estimated cost information
• Review the first January claims and EOBs
• Follow up on unexpected denials

Frequently Asked Questions

January billing doesn’t have to be a fire drill.

The key is getting the information in front of you early enough that you’re dealing with changes before they become problems.