Let’s Talk About Verifying Benefits (VOBs)

What is a VOB?

A VOB, or a Verification of Benefits is a process by which the insurance benefits are checked for a potential incoming client at a substance abuse or mental health facility. This process entails making sure their health insurance is active, the payments are up to date, finding out the deductible and out of pocket max, as well as a variety of other questions.

This process can either be done by someone in-house at a facility or it is often times done by the outside billing company.

Why are VOBs so important?

Verifying benefits for an incoming patient is crucial. By checking all of the information needed a facility will do its best at limiting any surprises when it comes to a patient’s insurance coverage, or more importantly what it won’t cover. In addition, because the billing cycle is typically a week behind, if a VOB is not done properly there is a chance a patient will be in your care without valid benefits and as a facility you won’t receive any financial compensation. VOBs are also often times used when it comes to payment appeals. If an insurance company comes back and says something isn’t covered, the biller can refer back to the VOB and use that as proof that payment should be given.

Most important factors of doing a VOB:

1. The right form asking the right questions

You can’t do a proper VOB without having the right questions to ask. Often times insurance companies aren’t always the most forthcoming with information so it’s imperative to make sure you’re armed with the right questions.This is important because often times different insurance companies have different stipulations, variations, and needs for each policy. That means each VOB form should have the correct questions for each of insurance company. Asking all the right questions will also help identify any red flag policies that could potentially slip through the cracks. For example, every VOB form needs to include the insurance representative’s name and reference number for the call – if that isn’t noted it will be near impossible to appeal a claim later on. Ideally, the VOB call is recorded to refer to if necessary during claim follow up or the appeal process.

2. Accuracy

Once you have the right questions to ask, the next step is to make sure everything is collected carefully and accurately. The information collected through a VOB is used by each facility to determine if a patient is going to be a good fit for their program. If the information collected is inaccurate, it doesn’t equip the facility to make the correct decision. In addition, as mentioned earlier in this post, VOBs are often referred back to and if the information is inaccurate this can affect every stage of the billing cycle.

3. Timeliness

The behavioral health space can often times deals with immediate crises. Calls come in at all hours from patients needing help. This makes it all the more important that a VOB be done in a timely manner as to not miss the window of opportunity to have a patient come in. There is always going to be variation depending on hold times but most VOBs can be done within 60 minutes during a normal business day.

4. Having the right data set to refer to

Once all of the information has been collected accurately and in a timely manner the final factor in determining whether or not an insurance policy is a good fit for a facility is the right data to compare it to. Even with all the right questions asked and information obtained, it can still be hard to determine how well a policy will pay. However, if you have a comprehensive data set to see how the same policy has already performed within a facility you’ll be able to make a much more informed decision. The bigger the data set you have to refer to, the less likely you are to run into a policy you’ve never seen that could end up not paying well. This is one of the benefits of using an outside billing company, they typically have a much broader scope when it comes to policy data.