Understanding VOB in Behavioral Health (Part 1): Why It Matters and Where to Begin

If you’re in the behavioral health space—whether you’re running a residential program, handling outpatient billing, or navigating solo practice insurance headaches—you already know this: getting paid isn’t always simple.

And yet, one of the biggest factors in whether your claims get paid—or don’t—happens before treatment even begins: the Verification of Benefits (VOB) process.

But here’s the thing: most providers and even seasoned administrators are still relying on incomplete, outdated, or downright misleading information when it comes to verifying benefits. That’s what this series is here to fix.

We see this all the time—facilities and billers relying solely on the insurance portal for member benefits. These quick portal checks might seem convenient, but they rarely offer the full picture.

Insurance portals can (and often do) omit:

• Medical vs. behavioral health carve-outs
• Limits on the number of sessions or days
• Authorization requirements
• Geographic restrictions
• Substance use vs. mental health benefit distinctions
• Accreditation requirements (JCAHO, CARF, etc.)

To get accurate, usable information, you must call the payer’s provider benefits line. Speaking to a live rep gives you the opportunity to ask precise questions, clarify codes, and gather the full story. Then—and only then—should you reference the portal to confirm or reinforce what you were told.

⚠️ Think of it this way: The portal is a snapshot. The rep on the phone is the source.

When you’re on that call, what you ask matters.

One of the first and most overlooked areas is whether the benefits you’re looking at are for substance use treatment or mental health—many plans split them out, and the coverage can differ drastically between the two. Don’t assume that just because “behavioral health” shows up on the portal, it covers everything you need.

While every detail in a VOB matters, some elements can make or break your ability to move forward. Start by confirming these key items:

• Plan type (HMO, PPO, EPO, POS): This determines whether out-of-network (OON) benefits even exist.
• Applicable CPT, HCPCS, and Revenue Codes: Ask for each level of care your program offers—even if you’re not sure the member will need them.
• Authorization requirements: Who authorizes care? Is there a third-party administrator? Are there penalties if you skip pre-auth?

You’d be surprised how often these critical details are skipped—and how often that leads to unpaid claims.

Even when you ask the right questions and take good notes, issues can still arise—especially if the VOB wasn’t completed thoroughly or early enough. Here are some of the most common pitfalls we’ve seen:

• Retroactive policy terminations – These happen when a policy shows as active during your VOB call, but is later updated to reflect an earlier termination date—meaning coverage was already inactive at the time of verification. While appeals are rarely successful in these cases, having a date-stamped reference number from the original call may help support your case, though it’s not a guarantee.
• Misquoted benefits – A rep may verbally confirm no exclusions, only for you to discover that a member’s policy has visitation limits, or the policy has OON benefits but not for the level of care you are requesting.
• Unconfirmed preauthorization requirements – Prior authorization requirements vary between payers. Some require authorization requests to be made prior to admission or the same day as admission, while others are more flexible. Understanding precertification requirements helps you to prioritize the utilization review process to ensure seamless coverage.
• Geographic or accreditation restrictions – Certain plans only cover treatment in specific states, or only at facilities with JCAHO/CARF accreditation. If you didn’t ask—or didn’t document—you may not have recourse if payment is denied.

The key takeaway? Verifying benefits is not just about coverage—it’s about documenting what you were told, when, by whom, and how it aligns with your services.

When it comes to VOB, timing isn’t just a best practice—it’s a safeguard.

The sooner you verify a member’s benefits, the sooner you can:

• Set accurate financial expectations for your team and the patient
• Catch roadblocks like authorization requirements or policy restrictions
• Avoid last-minute scrambles that delay admission or frustrate families.

Many payers have quirks that can impact your ability to even get benefits, depending on when you call:

• Some require the member to be admitted before they’ll release any benefit info
• Others won’t allow benefit checks unless the member has verbally authorized the release
• And in some cases, authorization timelines are tight—miss the window, and you’re stuck

Waiting too long can lead to:

• Avoidable delays in treatment
• Denied claims due to missed pre-auths
• Confusion at every stage—from admissions to billing to collections

In short: a thorough, well-timed VOB helps everyone—your team, your patient, and your bottom line.

If you’re reading this and realizing just how many moving parts go into a solid VOB—you’re right. That’s why we’re breaking this topic into multiple parts.

In the next post, we’ll walk through exactly what to ask, how to document it, and how to structure your VOB process so it’s consistent, thorough, and defensible—whether you’re verifying benefits as a one-person operation or training a new billing team.

We’ll also be sharing a downloadable VOB template that includes all the fields you’ll want to track—from policy information to coverage specifics, carve-outs, and payer reps’ disclaimers.

Until then, remember:

• Call the payer
• Document everything
• And don’t wait until it’s too late to verify

This is how you protect your revenue—and your team’s sanity.