Out of Network VOB Process Hits a Speedbump

VOBBy: Urgent Medical Billing, Guest Contributor

The verification process is an important step in the billing cycle. When done correctly the patient’s “VOB” will allow a healthcare provider to quickly determine if they can accept the patient for treatment or not. A good verification will tell a provider the general information about a patient’s insurance policy such as the deductible, the co-insurance and the out of pocket maximum. A very good verification will also include accreditation requirements, information on who would receive the payment for services, correct claims addresses for professional and facility charges and more. The quicker a verification is done, the sooner a patient can be brought into treatment. Speed and accuracy is the name of the game when it comes to insurance verification and United Healthcare, until very recently, was one of the quickest policies for an Insurance Verification Specialist to work with. 

They were quick and easy to verify and typically very solid policies. On May 9th, 2016 UHC’s subsidiary UBH/Optum implemented a new requirement for out of network providers to obtain benefits. Regardless of meeting the HIPAA requirements to obtain patient benefit coverage they now require the patient to call in and give verbal approval for an out of network provider to obtain coverage information.

This has slowed the process down tremendously. UBH/Optum maintains that the change protects patient privacy but simply using a web tool (i.e., Availity) you can get a snapshot of a patient’s policy information that they refuse to provide. The problem with this is the information on Availity is not complete. The extra important information such as accreditation requirements, payment information and claims addresses mentioned above are not available through a web vendor, thus forcing a patient to have to call in and provide benefit information to get the rest of the verification complete. Hopefully, other insurance carriers don’t follow suit by requiring this extra layer of patient security since these new delays in the verification process ultimately prevent patients from receiving treatment as fast as possible.

Urgent Medical Billing is a premier billing & collection service headquartered in Boca Raton, FL and provides highly skilled services exclusively for drug & alcohol treatment centers. Contact Dir. of Business Development Anthony Galgano via email agalgano@urgentmedicalbilling.com or by calling 954-292-7952 with questions. Download FREE Sample Interview Guide.

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