Verification of Benefits: Ask a Biller Episode 3

Having trouble verifying your client’s benefits?

Our third episode of “Ask a Biller” is out! Maggie and Dylan share tips & tricks for calling insurance payers to verify benefits.

See the full transcript here:

Maggie: 00:03 Hi there, and welcome to the third episode of Ask a Biller. My name is Maggie. I’m an insurance specialist here at SimplePractice.

Dylan: 00:10 And I’m Dylan, the medical billing specialist for SmartBilling Pro. We’re going to start with a new format this month where we’re going to do two webinars a month. The first one’s going to be a condensed webinar where we discuss one topic that you told us was very important to you, and then later in the month, we’ll follow up with a live Q&A. You’ll be able to find these on our blog.

Maggie: 00:32 Yes. You can send us your questions or what you would like us to cover, either through Facebook if you’re part of our SimplePractice Facebook community, or you can write in via our help center. Just make sure that the subject line there is Ask a Biller. We really appreciate your feedback, and it’ll help us decide what we want to cover.

Dylan: 00:53 Today we’re going to cover a topic that we get a lot of questions about, and that is verification of coverage.

Maggie: 01:00 Yes. A brief overview of what we’re going to cover today is what information you should collect from your clients, strategies to make sure that you have everything for the first time, and tips for calling the plan, as well as using online portals. We’ve also asked our Facebook community which payers they have the most difficulty working with, and we’re going to go over that at the end.

Dylan: 01:23 All right. With that, let’s get to our first question.

Glenda: 01:27 Do I have to call the insurance company to verify coverage?

Maggie: 01:31 Glenda, you don’t necessarily have to call, but we do recommend that you verify coverage in one way or another just to be sure. You may find that calling is going to be the most accurate, whereas checking online will be quickest but might not have all the information that you need.

Dylan: 01:49 We know it’s a very time-consuming thing, but the important thing to keep in mind is that you don’t want to start a new relationship with a client taking a gamble on their coverage, because this puts you in a tricky situation where either you’re writing it off or you’re deciding whether or not you have to charge the client. You really don’t want to start treatment with you and your client having this kind of problem, because you want to keep money and insurance and other things like that out of the session.

Maggie: 02:16 Yup. Let’s take another question.

Peter: 02:20 Can I check my client’s coverage before I begin seeing them?

Dylan: 02:24 Absolutely, Peter. I would have to say this is actually the best route you can take. Just like we were talking about before, starting things off on the right foot. What you really want to do is be able to verify the benefits, so that you know it’s an insurance you can accept and successfully bill. Then going forward, you and the client hopefully won’t run into any issues from there.

Maggie: 02:45 Yup. This is something that would definitely improve the experience for your client. Just taking care of that ahead of time really makes everyone’s life a little bit easier.

Dylan: 02:55 You’re going to want to collect a few things upfront. What you’re going to want is obviously your client’s name. It’s good to get a phone number and address, but the very important pieces you’ll need to run a verification are the insurance plan that they have, subscriber ID, name on the card if that’s different than the client, and their date of birth. From there, have them flip over the card and let them tell you the provider phone line. Then always ask if there’s a separate mental health or behavioral health line, because you may want to try calling that first.

Maggie: 03:30 Yup. The most important thing here is accuracy in recording your client’s demographic information. You want to make sure that you have everything according to how the payer has it. If your client just moved or has a new phone number, you want to be sure to collect whatever they had when they signed up for that insurance. Then if you can keep a copy of the client’s ID card on file, that will be super, super helpful to you if you ever need to refer back or call that plan.

Ashley: 03:58 What’s the quickest way to make sure that my client has coverage?

Maggie: 04:01 Ashley, this is a really great question. The quickest way you’ll usually find is going to be using online portals, if that is available for that payer. However, that might not always be the most accurate, especially when you’re working with verifying mental health coverage. You may find that, while the phone is the most time-consuming, it is generally the best way to verify coverage. We’ll go into why in a little bit more.

Dylan: 04:29 Yeah. As Maggie’s saying, unfortunately the path of least resistance is not going to yield the best results for you here. When in doubt, you’re just going to want to call the insurance companies.

Linda: 04:40 Hi. I would like to know the best ways to verify insurance.

Dylan: 04:46 All right. Well, there’s really just the two main ways. You’re going to have your online provider portals, sites like NaviNet and Availity. Then there’s the call. You’ve probably noticed that we’re drilling this home right now, but based on the nature of outpatient mental health coverage for a lot of clients out there, calling is going to be the most accurate. We’re going to help provide you with the tools and some strategies to make those calls be the most efficient and successful calls you can have. Once you do get used to certain insurance payers and you kind of know where the coverage lies for certain people who maybe work in certain industries and things like that, you might find that it’s very easy to go online to the portal and get the information you need. But again, we’re just going to keep saying it. When in doubt, you want to call.

Brock: 05:31 How do I know that the benefit information that I’m getting is accurate?

Maggie: 05:37 This is a really great question. While we can’t always guarantee that the information that you’re going to be given is 100% accurate, these things happen. Incorrect information is given, unfortunately, too often. However, we did put together some tips for you for calling the insurance and questions that you want to ask every single time, that we’re going to go over later in this video that will hopefully help to avoid those errors and avoid confusion in the future, so that you don’t have to deal with that.

Dylan: 06:07 Yup. This’ll be a thing too where practice makes perfect. The more you make these calls, the more comfortable you are navigating through the automated system giving that initial information and then making it to a representative, the more comfortable you get asking the right questions and kind of having a sense for when you’re not getting the full benefit information that you need. This will become like second fiddle for you at that point.

Emily: 06:32 Should I share benefit information with my client?

Dylan: 06:36 All right, Emily. This is probably my favorite question of the whole webinar, because this is a very important kind of push and pull that a lot of people deal with in their practice. Should you share verification benefit information with your client? This is entirely elective, so there’s a couple things that we want to think about. First of all, this is a really great service to offer your client, but if you are going to do that, you really want to make sure that in the intake paperwork they’re signing and in a verbal conversation when you guys are getting to know each other, that it’s very clear that what you are doing is just helping them understand what the insurance company is saying is covered, so that you’re not held liable in case there’s any issue with their coverage. Because again, we would hate for them to take you at your word and then be upset with you when things don’t work out. You don’t want that to get in the way of treatment, so it’s totally fine to help them understand their coverage, as long as there’s an understanding that they will be still responsible if it isn’t paid for.

Maggie: 07:38 Yup. We actually put together an example here of a verification of benefits form that you can use or you can base for your own, that we’ve made downloadable in our blog. Here’s an example of that here. Again, you just want to make sure that language is clear and that there is no misunderstanding between you and your client.

Dylan: 08:00 If you decide not to share VOB information with your clients, that’s fine. You’re still going to want to verify on your own, because one way or the other, you don’t want to walk into a new situation like that blind. Make sure you have the information, you know what you need to know, so that you can successfully bill your claims.

Meridee: 08:18 I’m not able to verify benefits through SimplePractice, because when I request a coverage report, there are no mental health benefits listed. I’ve tried for about 15 of my clients with various different plans, and I wasn’t successful with a single one.

Maggie: 08:31 Meridee, this is a great point. This is something that we really want to dive into. The reason why some payers don’t have very reliable coverage reports around mental health is because those payers commonly carve out their mental health coverage. We’ve actually brought in our colleague Charlie to go over exactly what that means.

Charlie: 08:53 (singing). Hi, this is Charlie here at Charlie Chats. Every time we do this episode, we will be deciphering the odd language of insurance-ese. Today we’re going to deal with a set of words that when you first saw them probably mystified you: carved out. Carved out is a term that refers to a particular service or services that clients’ medical insurance will cover but doesn’t manage. Very often, mental health coverage or pharmaceutical coverage will be carved out, meaning that it’s handled by an entirely different company. For example, and many of you have probably run into this, a client will give you a UnitedHealthcare card, but when you call UHC, they tell you that outpatient mental health is not covered. Later, you find out that the client’s mental health coverage is carved out to Magellan. As behavioral health clinicians, you need to be extra cautious when you are verifying clients’ coverage for precisely this reason.

Charlie: 10:13 Also, it’s not uncommon for a carved-out plan to not give out ID cards. Magellan, for example, is paperless, so your client might not even be aware that their mental health coverage is with a different company. That’s why it’s extremely important for you to verify coverage ahead of time and read the back of the card very carefully. If it says they do not administer behavioral health, this is a very good indicator that their coverage is carved out. I hope that makes the insurance part of your practice a bit simpler. Till the next time we meet here at Charlie’s Chats, this is Charlie signing off. Here’s Maggie and Dylan.

Maggie: 11:00 All right. Thanks for clearing that up, Charlie.

Dylan: 11:06 I just wanted to touch on something Charlie was using in his example. Again, Magellan is a great example of things to look out for. When coverage is carved out to another payer, a very important question you’re always going to want to ask is what is the subscriber ID for that plan, because often what you’ll find is that there’s an entirely different subscriber ID, or in the case of Magellan, it’s going to be either a different alpha prefix if it’s from a Blue Cross Blue Shield plan, or sometimes in the case of United, what it is, it’s the same ID number but it’ll have a couple more zeroes, maybe two, maybe three, it varies, ahead of the number. Without having that correct subscriber ID, you’re not going to successfully bill your claims. Per usual, always get the subscriber ID for the carved-out plan, and while you’re at it, make sure you know what the exact payer ID is.

Maggie: 11:58 Details, details, details, they matter here.

Michael: 12:02 My problem is I’ll go and verify coverage, and all of the medical copays are listed, but the mental health benefits won’t be. What happened to parity?

Maggie: 12:12 Michael, as we explained with Meridee’s question, this could be that your client’s coverage is carved out to a different company or to a different payer, but what also may be the case is that a lot of these payers are experts in medical coverage. They don’t have as much information available online regarding mental health coverage. Usually their coverage reports are basic and cover the structure of the medical benefits, but they don’t go into the details that may be necessary to verify the services that you provide. That’s why it’s really important, if that information is not available online, don’t just assume. Always call the plan. You want to be sure that you verify exactly who’s covering these services and who you need to speak with to make sure.

Dylan: 12:59 Yeah, and just like Maggie was saying, kind of the harsh reality here is that these portals, these online websites where you can check benefits, are generally not very helpful for outpatient mental health. Oftentimes, it’s left blank. Oftentimes, you just get the medical general benefits. Until there’s some sort of great updating to the way that they work, especially in relationship to mental health, that’s why we’re going to keep telling you to call.

Maggie: 13:24 In an effort to make your life a little bit easier and make calling the insurance a little more painless, we’ve put together some tips for calling. Our first tip is to avoid calling on Monday if you can, the reason being is that Mondays are usually the busiest days for customer service. You’ll find that those will be the longest hold times.

Dylan: 13:48 Yeah. Don’t make your Monday any more busy than it probably already is. Another part of this is that a lot of people find time on the weekend to seek treatment and look into what kind of clinician they feel comfortable calling. You may find that you build up a lot of verification requests over the weekend. It’s okay to go ahead and start seeing if you can schedule them. Just make sure that you get to those benefits before they’re supposed to come in, so that if anything kind of crops up where there’s no coverage or there’s an issue, like maybe you’re out-of-network so their responsibility is going to be greater, you have time to communicate that with them before the session.

Maggie: 14:28 Yup. We actually find that calling on Wednesdays is the best day of the week, just because it’s in the middle of the week. Hold times tend to be the lowest. That being said, we also recommend calling early in the morning or late in the day. Avoid calling in the middle of the day. Those are the highest hold times. That’s when people are trying to call on their lunch breaks. If you’re on the East Coast, you’ll have the advantage of calling in the morning. You’ll have the lowest wait times. If you’re on the West Coast, call at the end of the day. You’ll have the lowest wait times. Then another recommendation is just to put some time in your calendar if you know that you’re going to have to do this. That way, it’s scheduled. You can’t avoid it. You can collect multiple clients at once, so that when you call, you can get it all taken care of in one time block.

Dylan: 15:18 The strategy for this that I would use is you want to start to make little sections by payer. Maybe you build up three or four people for Blue Cross Blue Shield, and then four or five for Aetna. That way, you’re not making one call per verification request. That way, you can kind of piggyback a few things on top. Once you have a few clients that you want to check with Blue Cross Blue Shield, you can knock them all out at once. Then while you have the representative on the phone, that’s a great time to ask other questions. Maybe you’ve been wondering about Telehealth, let’s say. You could ask them about the requirements in billing for something like that, or you can actually just get transferred over to the claims line if you have a couple of denials you want to knock out while you have them on the phone. The more you can stack up to make less calls and use that time better is highly recommended from me and Maggie.

Maggie: 16:08 Yup. Before you even pick up the phone, you want to make sure that you’re prepared. Have all the information that you know that they’re going to ask. Have the client’s demographic information prepared, as well as a copy of their ID card if you have that, the policy number, things that you know that they’re going to need right away. You don’t want to scramble to have to find that once you finally get a representative on the phone. The other thing that we recommend is to check multiple procedure codes. As Dylan said, if you don’t know which way the treatment’s going to go, it’s better to just verify every service that you offer, so you have it on file there. You don’t have to call back. Then if the electronic prompts are endless and you find that you’re stuck, it’s helpful to just hit zero or say representative until you can talk to a live person.

Dylan: 16:59 Yup. The way that usually works is you’re going to have to make it through those first few initial steps. You’ll call. You’ll choose the eligibility and benefits line. Usually you’ll have to enter either your NPI or your tax ID number, then the subscriber ID, sometimes date of birth. But once you get to the part where the automated system is going to read you the generic benefits, don’t waste your time there. That’s where you want to ask for a representative. That’s where you want to try to push zero. That’s where you’ll get connected to a live person who can give you actual outpatient mental health benefits that you’re looking for.

Maggie: 17:31 Yup. Then always, always, always record the name of the representative, and ask for a call reference number. You should do this at the top of the call. If your call gets disconnected or if you are transferred, you want to be sure that you have that information and that you have a record of when you called, who you spoke with, so if you ever need to call back and dispute something, you have that on hand.
Dylan: 17:56 Then a little pro tip for you guys too. If you do find yourself on a call where they’re going to transfer you to another line, maybe you’re just in the wrong department, maybe it’s carved out, ask them for the number and write it down, because a lot of times when you get transferred, the call drops. You don’t want to have to start all the way back at the beginning calling the primary insurance, navigating your way through the automated system, just to try to get the connecting phone line. Always grab that before they transfer you.
Maggie: 18:23 Yup. Then the final tip is if you don’t feel like you’re getting the right information or if you don’t feel like you’re getting anywhere, don’t hesitate to just hang up and call back. Speak to a different representative. Sometimes that can help, or if it comes down to it, don’t hesitate to ask for a supervisor. Sometimes that is the best way to get the information that you need.
Dylan: 18:45 Sometimes you might just be speaking with someone who is a little less experienced or maybe is having problems navigating the computer system that they’re on. Things like this just tend to happen when you call into those lines. Don’t feel shy to just politely ask to speak with someone else. If you feel like you’re having problems communicating about the information you need or getting the information you need, it’s totally fine to just ask for someone else.

Maggie: 19:09 Yup. In addition to these tips, we also put together a script of general things that you want to say every time that you call insurance. This’ll be really helpful if you’re just getting started. You can read these word for word. The most important thing that we recommend is right off the bat mentioning that you’re going to be verifying coverage for outpatient mental health services. This should be an indicator to that representative of where you need to go and who should be verifying this coverage. They will know right off the bat if they’re the right person or not, and that way, hopefully save you some time if you need to be transferred.

Dylan: 19:47 Yeah. That’s a really great tip, because you’ll find that if you just start getting into answering all their questions about who you are or where you’re calling from, your information, client information, by the time they ask you what type of benefits you’re looking for, you may find quite often that they’re not the one that can even help you. Starting off the conversation when they say, “What are you calling about?” with just, “I’m looking for outpatient mental health benefits,” will save you a lot of time.

Maggie: 20:14 Yup. We actually made this script available on our blog. You can download this, keep it on record, use it any time that you call to verify coverage. Then the next thing that we want to add is that you make sure that, after you put in all this work calling the plan, recording this information, make sure to store it somewhere where it’s easily accessible within either your SimplePractice account, or if you have files that you keep for your clients. Within SimplePractice, you can easily record this information on a chart note and keep it in the client’s overview. What you can do is mark the date on the chart note to far in the future, so that any time that you open the client’s overview, it’ll be at the top of the page, all the information regarding their coverage.

Dylan: 21:01 Yup. That’s a really great tip if you want to quickly review or follow up with a client who is asking you about coverage. I want to circle back on this point too and say that this information is something you should probably think about building into your intake paperwork. That way, when the client has signed the intake and the agreement is understood, you guys can both feel confident sharing that VOB information and understanding that it’s not a guarantee by you of coverage. That way, your bases are covered, and you’ll be able to protect the relationship that you guys are starting to build in treatment.

Maggie: 21:37 Great. The next thing that we want to go over is a question that we asked our customers in our SimplePractice Facebook community. That is, what payers do you have the most difficulty working with to verify coverage?

Dylan: 21:52 Yup, and we got a lot of people writing in saying that they were having a really tough time with Aetna and Cigna. We’ve found this to be true as well. A lot of times, you call into Aetna, and you just feel like you don’t get the right information. Then you find out later once you’ve billed the claims that you didn’t get the right benefit information. We like to use Availity or NaviNet a lot of times for these, because they have pretty clear benefit information. You can choose outpatient mental health, and that makes it really clear. Another thing that’s really important when verifying in general is making sure you make it clear if you’re out or in-network, because the benefit levels are gravely different. If you get in-network coverage when you’re actually out-of-network, this can be a big miscommunication for you and your clients. If you don’t know your network status, just ask.

Maggie: 22:42 Yup. Then a few of you had also mentioned that UnitedHealthcare is one of the payers that you have trouble with. We find that their portal is actually really user-friendly and easy to navigate. That is Hopefully some of the tips that we went over in this video will help you to feel more prepared and more confident in tackling those verification of benefits for your clients.

Dylan: 23:06 The thing that I also like about Provider Express is that it’s very easy to store clients there. You only need the subscriber ID and their first name, and then you can just add them to your list of patients. That way, it’s easy to review their coverage or claims later without having to put their demographic information back in. All right. Thanks everyone for tuning in to this episode of Ask a Biller. Don’t forget, we’ll be doing a live webinar where we’re going to do a Q&A where we cover more things to do with verification of benefits. That’s going to be happening Thursday, April 12th, at 1:30 PM PST. Keep the questions coming, and tune in for that too.

Maggie: 23:46 Yup. You can register for that webinar within your SimplePractice account. You’ll see a link, or else through this link in our blog. You’ll be able to submit your questions ahead of time. Remember that if you have questions that are specific to your SimplePractice account about insurance, that we offer an insurance billing class on Tuesday at 11:00 AM PST and Thursday, 3:00 PM PST. That is it for today. As always, keep it simple.
Dylan: 24:18 Keep it simple.

Below, you’ll find resources mentioned in the video, including:

  1. Slides from the webinar
  2. A one-page guide for verifying benefits

Every month, we’ll focus on one aspect of insurance. There will be an hour-long live Q&A on the second Thursday of the month and an official episode posted on the 4th Thursday.

Webinar slides:


Verification of Benefits Tips:

Watch more “Ask a Biller” episodes here:

Episode 2: Telehealth & Insurance

Episode 4: Client Payment Types

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