You can build a beautiful clinical program, hire excellent therapists, and nail your admissions process — and still watch your revenue collapse because your VOB workflow is a mess. Verification of benefits for addiction treatment is the unglamorous engine room of every IOP and PHP. Get it right, and your admissions move fast and your cash flow is more predictable, because you’re reducing preventable eligibility and coverage-related denials up front. Get it wrong, and you're chasing denials, eating write-offs, and burning out your billing staff. cms.officeally
Here's what you actually need to know.
What a VOB Is (and What It Isn't)
A verification of benefits is the process of confirming a patient's insurance coverage before they start treatment. You're checking whether their plan covers the level of care you provide, what their deductible and out-of-pocket maximum looks like, whether prior authorization is required, and what your reimbursement rate might be. In addiction treatment, that usually means drilling into the behavioral health or substance use disorder (SUD) benefits, which are often administered separately from general medical benefits under carve-out arrangements. nashp
What a VOB is not is a guarantee of payment. A payer confirming that coverage exists does not mean they've agreed to pay your claim; payment still depends on factors like medical necessity, coding accuracy, and timely filing. That's why every VOB needs to be paired with a solid prior authorization strategy and documented carefully. gauthmath
Why VOBs Break Down at Most Treatment Centers
Most VOB failures come down to three things: speed, accuracy, and documentation.
Speed is a real constraint at the admissions stage. Patients in crisis are often unwilling or unable to wait days while your team plays phone tag with insurance companies, and delays in eligibility and benefit verification are a known driver of lost or delayed revenue in medical practices generally. If your VOB process is slow, you're likely losing admissions to providers who can move faster. cms.officeally
Accuracy is where many billing disasters originate. A VOB done by someone who doesn't know how to read a behavioral health benefits summary — or who doesn't ask the right questions — will leave out critical details. Did they confirm whether your specific procedure codes (for example, HCPCS H0015 for intensive outpatient substance use treatment and S9480 for intensive outpatient psychiatric services) are covered under the member’s plan? Did they ask about mental health parity rules, network status, and cost-sharing structures for behavioral health versus medical, given that parity law requires financial requirements and treatment limits for behavioral health to be no more restrictive than for medical-surgical benefits when covered? Small omissions at this stage can turn into large claim denials later. pmc.ncbi.nlm.nih
Documentation is the unsexy part everyone skips. If the person who ran the VOB leaves your organization, or if an insurer disputes a claim months down the road, your notes need to hold up. Maintaining detailed documentation about verified insurance information is widely recommended for audit readiness and denial prevention. Date, time, rep name, and any reference or call ID number — every call should be logged. cms.officeally
The VOB Process for IOP and PHP Programs: Step by Step
Step 1: Collect the Patient's Insurance Information Before the Intake Call Ends
You need the member ID, group number, the subscriber's date of birth, and the plan name at minimum. If there's a secondary insurance, capture that too, since primary–secondary coordination can significantly affect payment. Don't wait until the day of admission; front-loading this step gives you time to clarify coverage or authorization issues before the patient arrives. cms
Step 2: Call the Behavioral Health Line — Not the General Member Services Line
Many commercial plans use separate behavioral health organizations or specialized units to manage mental health and substance use benefits, particularly in Medicaid managed care and some employer-sponsored arrangements. Calling the wrong department wastes time and often produces incomplete information, because general reps may not have visibility into carve-out behavioral health benefits or SUD-specific limitations. nashp
Step 3: Confirm These Specific Items
When you're on the call, work through this list:
Is the member currently active and eligible?
Does the plan cover PHP (Partial Hospitalization Program) and IOP (Intensive Outpatient Program) separately?
What is the deductible, and how much has been met this year?
What is the out-of-pocket maximum, and how much has been met?
Is your facility in-network or out-of-network? (Know your status before you call.)
Is prior authorization required for PHP and IOP? If so, how many days are typically approved in the initial auth? Prior authorization is a common requirement and a frequent source of behavioral health denials when missing or incomplete. billingparadise
Are there any restrictions on substance use disorder treatment specifically?
What is the timely filing deadline, given that many commercial plans use windows somewhere between about 90 days and one year from the date of service? chbmdbilling
Ask for a reference number at the end of every call. Write it down in your notes or EHR.
Step 4: Translate the VOB Into a Patient Financial Estimate
After you run the VOB, convert it into plain language for the patient. Tell them approximately what they'll owe out of pocket before their deductible is met, and give them a realistic sense of what treatment will cost them. Providing patients with written information about their financial responsibilities is a recommended revenue-cycle best practice and helps reduce confusion and complaints later. cms.officeally
Step 5: Document Everything in Your EHR or CRM — Before the Patient Starts Treatment
This is non-negotiable if you want to defend yourself on appeal. If a claim gets denied and you have to fight it, the VOB documentation becomes part of your evidence that you verified coverage and followed the plan’s stated rules. If you can't produce it, your appeal is weaker. Log the full call summary, not just the benefit figures. billingparadise
Insurance Verification for IOPs: Common Pitfalls to Avoid
Assuming commercial coverage means behavioral health coverage. Some self-funded employer plans historically excluded or limited behavioral health services, which is part of why federal parity laws like the Mental Health Parity and Addiction Equity Act (MHPAEA) were enacted. Today, behavioral health can still be carved out to a separate administrator, so you should always confirm the actual mental health and SUD benefits rather than assuming they mirror medical coverage. pmc.ncbi.nlm.nih
Not checking for prior auth requirements on the first call. If prior authorization is required and you miss it, your claim is at high risk of denial even if the care was clinically appropriate. Many providers describe prior auth as one of the biggest administrative burdens in behavioral health, in part because requirements vary by payer and product. adonis
Running VOBs without clinical context. Whoever is verifying benefits needs to understand the difference between PHP and IOP, and which level of care the patient is actually being admitted to. Verifying IOP benefits when the patient clinically needs PHP is a billing error waiting to happen and can create medical necessity and coding mismatches — both common sources of denials. billingparadise
Failing to re-verify for extended stays. Benefits can change during the plan year due to events like employment changes or plan switches, especially for Medicaid beneficiaries who may move between managed care plans. If a patient is with you for multiple weeks, building in a secondary verification around the midpoint can help you catch authorization limits or eligibility changes before they disrupt payment. nashp
How to Streamline Your VOB Workflow Without Cutting Corners
The most efficient treatment centers often batch their VOB calls at consistent times each day — typically early morning when hold times are shorter — and use standardized forms or templates so every staff member collects the same data every time. They also cross-train at least two people to run VOBs so admissions don't stall when someone is out sick or on vacation. cms.officeally
If you have steady volume, it may be worth evaluating whether dedicated internal staff, automation tools, or external vendors make sense for your organization; many providers find that preventing just a small number of high-dollar denials easily offsets the cost of more robust eligibility and benefit verification processes. The exact break-even point will vary by market and payer mix, but the principle is the same: avoid preventable revenue leakage at the front end. billingparadise
Real-time eligibility (RTE) tools, which are integrated into many EHR and practice management systems, can surface basic eligibility data in seconds by querying payer databases electronically. They don't replace a full VOB call, but they're useful for a quick pre-screening before you invest the time in a more detailed verification. questns
What Happens When You Skip or Rush the VOB
When eligibility or benefit issues surface after services are delivered, providers can lose a substantial portion of expected revenue to denials, write-offs, and rework. Industry analyses suggest that each denied claim can cost providers additional administrative dollars to appeal, on top of the delayed or lost payment — and behavioral health practices often experience higher denial rates than many other specialties due to documentation, coding, and authorization issues. siriussolutionsglobal
Beyond the money, admissions errors erode trust with patients and families. If someone starts treatment believing they have coverage and later receives an unexpected bill, the fallout can damage your reputation, prompt complaints, and make patients less likely to continue care or recommend your program.
FAQ: Verification of Benefits for Addiction Treatment Centers
What is a VOB in addiction treatment?
A verification of benefits (VOB) is the process of confirming a patient's insurance coverage before they begin treatment. In addiction treatment, this means verifying whether the patient's plan covers the level of care being offered — such as IOP or PHP — along with their cost-sharing responsibilities, prior authorization requirements, and network status. pmc.ncbi.nlm.nih
How long does a VOB take for behavioral health?
The time it takes can vary, but a thorough VOB call often requires enough time to navigate phone trees, wait on hold, and review complex benefit details, especially for plans with separate behavioral health administrators. Many centers plan for at least a full call cycle so they can confirm eligibility, benefits, prior auth rules, and timely filing limits in one go. nashp
Can a VOB guarantee insurance payment for treatment?
No. A VOB confirms what a patient's plan is supposed to cover, but it is not a pre-authorization and does not guarantee reimbursement; claims can still be denied for reasons like lack of medical necessity, missing prior auth, coding errors, or late filing. gauthmath
What's the difference between a VOB and a prior authorization?
A VOB tells you what the plan covers and at what cost-sharing level based on the member’s benefits. A prior authorization is a separate approval process where the payer reviews clinical information and authorizes a specific treatment episode or number of days before care begins — and many behavioral health plans require both steps. adonis
How do I avoid insurance claim denials for my IOP?
The main levers are accurate VOBs, timely and complete prior authorizations when required, coding that matches the level of care actually provided, and clinical documentation that supports medical necessity. Most preventable denials in behavioral health trace back to one or more of those areas. adonis
Do I need different VOB processes for Medicaid versus commercial insurance in an IOP?
Yes. Medicaid behavioral health benefits vary significantly by state and are often delivered through managed care organizations with their own rules, authorization processes, and timelines. Commercial insurance VOBs tend to follow more standardized patterns but still differ by payer, so your billing team should have separate playbooks for each payer type. nashp
A Note on Getting the Business Side Right...
ForwardCare is a behavioral health MSO (Management Services Organization) that partners with clinicians, sober living operators, healthcare entrepreneurs, and investors to launch and scale behavioral health treatment centers. We handle the business side — licensing support, insurance credentialing, billing, compliance, and operational infrastructure — so our partners can focus on growth and clinical quality.
If you’re serious about opening or expanding a behavioral health treatment center but don’t want to navigate the business side alone, ForwardCare may be worth a conversation.