Verification of Benefits. When, What, How & Why?

So you just landed yourself a new client! Congrats! WOOO HOOOO!

Once the glitter and confetti stops falling, there is one BIG, huge, important job to do. 

Grab the broom! just kidding!

Grab the broom! just kidding!

Of course, I need to see this client AS soon as possible!
— You

Yes, but this first!


Hold that SIGH. Surely, you like getting paid right? Cause if your doing this biz for free, I can send you all sorts of clients! Clear the sidewalks, and I will line them up for you! Soon your office foyer will look like Black Friday at 4 a.m.



Running a verification of benefits, also known in the insurance and billing world as a VOB, & is the key factor in ensuring quick and seamless billing procedures going forward. 



  1. Anytime you schedule a new client
  2. Anytime an existing client undergo's an insurance change
  3. Anytime someone questions their benefits or you question your reimbursement
  4. The start of every new insurance year
  5. Every 30 days for clients with high deductible


So you listened, and you got a copy of the patients insurance card.

{insert high five, insert low hanging head if you did not}

If you flip that plastic piece of heaven over (the card) there is a provider phone number listed.

Grab some coffee, get a magazine and dial that baby up.

Your listening for Eligibility & Benefits as an option.

Go ahead, throw it on speaker and do your best Jane Fonda until someone answers. 


Have your billing npi & tin handy.... your going to need it.

i promise. 


What questions do I ask?

  1. You are asking for outpatient mental health benefits; in an office setting
  2. 90834 & 90837
  3. does deductilble apply?
    1. if so, how much is the deductible, and how much has been applied
  4. CO-PAYMENT/co-insurance?
  5. out of pocket max
  6. prior authorization
  7. visit limit/max
  8. billing address/payer id for electronic submissions



 You do like running water? indoor plumbing? starbucks triple fat soy vanilla lattes? 

simply---- because you like getting paid. 


Top Reasons for Claim Denials {those in italics could be avoided with a vob}

  1. The client isn't eligible for services because their health plan coverage has ended.
  2. The clients insurance has changed, and they have not received a new card so the supply you with old information {assuming you know that it changed right? cause you're the professional}.
  3. The deductible is 1.3 million dollars and they haven't met it yet {ok, so that might be a little exaggerated, but for real in Mental Health how often are you going to meet the 10,000.00 deductible on sessions alone?}
  4. Some services are carved out to other vendors. Just because the client presents a Blue Cross Blue Shield card and you are paneled with them, does NOT mean you will get paid if their benefits are carved out to a vendor you are not par with. 
  5. Benefits have been exceeded. Some clients jump on the therapist merry-go-round, and this can exhaust benefit coverage.
  6. Particular services are not covered under the benefit plan. Some plans will only cover 90834, while others cover 90837. One plan might allow for family counseling, while another does not. Verify the codes you plan to use in treatment. 
  7. KNOW YOUR TIMELY FILING LIMITS {you do NOT always have 365 days to file a claim, actually more often than not, you have far less}. If you don't have correct insurance data to start with, you could have a hard time getting it corrected after a denial. Especially if the client jumps ship.
  8. Errors in data. If the client is the subscriber to the insurance you will typically have all the data required. To ensure clean billing, if the client is not the subscriber ALWAYS collect the Name, Date of Birth, Relationship & Address of the subscriber. I also HIGHLY recommend ALWAYS getting a scan or picture of all insurance cards. 


Look at that! 

{8} avoidable claim issues that could be

RECONCILED, prevented or corrected with one

verification of benefits.


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