Verification of Benefits: Why Are They Important? - Synergy Concepts behavioral health medical billing and coding

Verification of Benefits: Why Are They Important?

Verification of benefits and verification of patient insurance coverage are similar, but there are key differences. Many people have insurance that will cover traditional hospital and clinic visits but have some restrictions on addiction treatment coverage.

When you go through the verification of patient insurance coverage, you get the status of the patient’s insurance. If the patient’s policy is active, the insurance will cover the patient for as long as they are paying premiums. However, just because a patient’s insurance is active, it does not mean that the insurance covers all services. This is where the verification of benefits comes into play.

Check Verification of Benefits

Check Your Verification of BenefitsWhen a medical biller checks the verification of benefits, they are seeing that the patient is covered for certain services. The biller will also see how much the insurance companies will pay for these services.

The verification of benefits is more crucial than the verification of patient insurance coverage. The insurance provider may not pay for the cost of specific services, even if the patient has an active status. Insurance verifications services are responsible for determining how much money insurance companies owe for each type of service the patient is using. The verification also shows who is responsible for paying what.

If a clinic utilizes a service that the insurance does not cover, the insurance provider will not pay for it. They will leave it for the patient to pay, instead. Being a part of an insurance plan does not guarantee that all medical expenses will be covered.

This is important for the insurance verifications service because they need to explain to the patient why they have to pay. The verification of benefits will show why the patient has to pay out of pocket. It will also show how much they owe. Most patients do not understand why their insurance will not cover their medical costs, and will often refuse to pay.

Verification is Crucial

It is crucial that when a patient verifies their coverage, they also verify their benefits. This ensures that the insurance provider covers what the patient owes to the behavioral health facility. A patient has the chance to verify their benefits when they verify their insurance coverage.

You and your patient need to know which services the patient's insurance covers when the patient comes into your facility.You and your patient need to know which services the patient’s insurance covers when the patient comes into your facility. Verification of benefits involving substance abuse treatment needs to happen if a patient is going to a rehab facility. The patient needs addiction treatment, but the patient will also need to know what expenses they are responsible for.

Many treatment facilities have forms to verify a patient’s benefits. A patient lists the known services that their insurance provider pays. During the addiction treatment process, it is important to know what services the insurance covers for the patient.

However, the responsibility of the patient’s own expenses may change. For instance, some rehab clinics require a copayment for certain treatment visits, and some services, like family addiction treatment models, may not be covered.

Not every insurance policy is the same. Coverage, expenses, and services may vary from patient to patient. This is why the verification of benefits is so crucial before checking into a behavioral health addiction treatment facility.

Have questions about behavioral health or addiction treatment medical billing or revenue cycle management? Contact us today. We have answers.

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