A free script from Quick VOB
The VOB call script: what to ask the insurance rep, level by level
A word-for-word script for the benefits call, from the phone menu to the reference number, with question blocks for detox, residential, PHP, IOP, outpatient and mental health care, and what to say when the rep pushes back. Print it, or keep it open next to the eligibility response.
Updated October 24, 2026. Written by the admissions team of a licensed Texas IOP/PHP program; it's the same set of questions Quick VOB's call log is built around.
The short answer: call the behavioral health or provider number on the back of the card, choose "provider" in the phone menu, and give your organization's NPI and tax ID. Then confirm the member, ask the plan-level questions the electronic check didn't answer, and for each level of care ask three things: is it covered in network, is prior authorization required (and how it's requested), and how many days or visits are approved at first and when the review is. Ask whether another company manages behavioral health. Before you hang up, get the rep's name and the call reference number, and read it back.
Before you dial
| Have ready | Why |
|---|---|
| Your organization's NPI, tax ID, taxonomy, address and phone | Phone menus ask for the NPI and tax ID before they route you. The taxonomy is how the payer decides what kind of provider you are. |
| The member's name, date of birth, member ID (with prefix) and group, and the subscriber's name and date of birth if the member is a dependent | A mismatch on any of these is the usual reason for "member not found." |
| The electronic check (271) | So you only ask what it didn't answer. Our guide to reading a 271 shows what it usually leaves out. |
| The levels of care you might use | Ask about the next level down too: PHP and IOP if you're admitting to residential, IOP and OP if you're admitting to PHP. |
| Signed consent, for a 42 CFR Part 2 program | Under Part 2, someone who has applied for substance use treatment at your program is already a patient, so the call itself is a disclosure. |
| The printable VOB form | Each answer below has a box on it. |
The script
Step 1The phone menu
- Listen to every option before you choose. When asked who's calling, choose provider (or "facility," or "behavioral health provider").
- Key in your NPI, tax ID and the member ID when asked.
- If the menu won't route you, say "representative" or "agent."
Step 2The opener
"Hi, this is [your name] calling from [facility], NPI [NPI], to verify behavioral health benefits for a member."
If they ask, give: the member's name, date of birth, member ID and group; the subscriber's name and date of birth; your tax ID, address and phone. Give nothing else about the member: no diagnosis, no history. A benefits question doesn't need it, and HIPAA's minimum-necessary rule applies to disclosures for payment (45 CFR §164.502(b)).
Write down: rep's first name time
Step 3The plan
- "Can you confirm the coverage is active, and the plan's start and end dates?"
- "Is this plan fully insured or self-funded?" (A card without TDI or DOI is usually self-funded, per the Texas Department of Insurance.)
- "What are the in-network deductible and out-of-pocket maximum, individual and family, and how much is left of each?"
- "Does the plan have out-of-network benefits? What are the out-of-network deductible, out-of-pocket maximum and coinsurance?"
- "Is behavioral health managed by another company? What's their name and number, and the member's ID with them?" If yes, finish with this rep, then call that company and start again at Step 4.
Step 4Every level of care: the three questions
For each level you might use, ask:
- "Is [level] covered in network for this member? What's the coinsurance or copay, and does the deductible apply?"
- "Is prior authorization or precertification required? Who handles it, and how: phone, fax or portal? How far ahead, or how soon after admission?"
- "How many days or visits are usually approved at first, and when is the first review?"
Then the level's own questions below.
DetoxWithdrawal management
- "Is withdrawal management at our facility a behavioral health benefit or a medical benefit? Who reviews it?"
- "Precertification before admission, or notice after? How many hours? What's the after-hours number?"
- "Which criteria do you use for medical necessity: ASAM, or your own?"
ResidentialResidential treatment
- "Is residential substance use treatment covered for this member? In and out of network?"
- "Is there a yearly day limit, and how many days are used?"
- "Is room and board included in the per diem, billed separately, or excluded?"
- "Does the facility need a particular license or accreditation for residential?"
PHPPartial hospitalization
- "Does the plan require a minimum number of hours or days a week for PHP?"
- "Is PHP billed per diem? Which revenue code and claim form do you expect?"
- "If the client steps down to IOP, is that a new authorization?"
IOPIntensive outpatient
- "Is IOP authorized as days or as visits? Is notification enough, or is a full authorization needed?"
- "Do you want IOP billed per diem, for example with H0015 for substance use or S9480 for psychiatric IOP, or per service?"
- "Is there a minimum number of hours a week?" (For Original Medicare, the plan of care must call for at least 9 hours a week, per Medicare.gov.)
OPOutpatient
- "Is there a visit limit, or a number of visits after which authorization is needed?"
- "Which provider types can bill for this member's plan: licensed chemical dependency counselors, associates under supervision?"
- "Is telehealth covered at the same cost share?"
Mental healthFor a mental health program
Ask the same blocks with "mental health" in place of "substance use": psychiatric PHP and IOP, outpatient therapy, and psychiatric visits. Ask whether psychiatric medication management is billed under the mental health benefit or the medical one.
CloseBefore you hang up
- "Can I have your name and the reference number for this call?" Read the reference number back.
- "Is there anything about this member's plan I didn't ask that would affect a [level] admission?"
- "Thank you."
Write down: rep name reference # date and time
When the rep says…
| The rep says | You say or do |
|---|---|
| "Benefits quoted are not a guarantee of payment." | "Understood. Can I have the reference number for what you've told me?" It's true, and it's why the reference number matters. |
| "I can't give you benefits for your provider type." | "What provider type do you have on file for our NPI?" If it's wrong, the fix is your taxonomy or your enrollment with the plan, not this call. Ask what number credentialing uses. |
| "Behavioral health is handled by another company." | Get the name, number and the member's ID there, then call them. See carve-outs. |
| "No authorization is required." | "For [level], at a facility, in network, starting [date]? Can you note that on the call?" Then get the reference number. |
| "I don't see a PHP (or IOP) benefit." | "Which benefit would it fall under: outpatient facility, mental health, substance use?" A plan that covers medical care at a level generally has to cover behavioral health in the same classification under the parity law (CMS), so ask them to check and note it. |
| "Member not found." | Re-read the ID with its prefix, try the subscriber's details, and confirm the date of birth. |
| "You're out of network." | "Does the plan have out-of-network benefits for [level]? Who handles single-case agreements?" Then read out-of-network benefits before you quote anything. |
Make the call shorter
- Run the electronic check first. The deductible, out-of-pocket and coinsurance come back in seconds; the call is only for what the 271 didn't say. Our VOB checklist splits the two.
- Call the right number first. The behavioral health number on the card, or the carve-out the 271 names, not the general member line.
- Call early in the business day. Provider lines answer business hours on weekdays; the after-hours line is for precertification, not for benefits.
- Log as you go, not after. In Quick VOB, each check has "Log the call": covered, authorization and days or visits for detox, residential, PHP, IOP and OP, plus the rep's name, reference number and time. The behavioral health number from the card is one tap away on a phone, the log saves as you type, and it goes on the VOB PDF and into "Copy for my EHR."
- Hand the family the money part separately. Use the deductible and out-of-pocket scripts once you have the numbers.
Questions
What questions should I ask when verifying insurance benefits for rehab?
Whether coverage is active and the plan dates; the deductible and out-of-pocket maximum with what's left, in and out of network; the coinsurance or copay; whether another company manages behavioral health; and for each level of care, whether it's covered, whether prior authorization is required and how, and how many days or visits are approved at first. Finish with the rep's name and the reference number.
What information do I need before calling the insurance company?
Your organization's NPI, tax ID, taxonomy, address and phone; the member's name, date of birth, member ID and group; the subscriber's name and date of birth if the member is a dependent; and, for a 42 CFR Part 2 program, the signed consent.
Can I verify benefits without calling?
Partly. An electronic eligibility check answers coverage, deductible, out-of-pocket and coinsurance in seconds. Level-of-care coverage, authorization rules and the days approved usually still need a call.
Why does the call reference number matter?
It ties what the rep told you to a record at the plan. If a claim is denied against what the rep said, such as "no authorization required," the reference number, date, time and rep's name are your evidence on appeal.
Should I give the diagnosis on a benefits call?
Not for benefits. Give only what the rep needs to find the member and your organization. Clinical details belong in the authorization request, which goes to the reviewer the plan names.
How long does a VOB call take?
It depends on the payer's phone menu and hold time. Running the electronic check first and calling the right number cuts it down, because you only ask what the check didn't answer.
Log the call where the benefits are
Quick VOB puts the call log next to the payer's answer, by level of care, with the rep and the reference number on the PDF. $99 a month for the whole team, checks usually about $1, $200 setup. See the call log in the tour.
Sources
- 45 CFR §164.502(b), the HIPAA minimum necessary standard. ecfr.gov
- 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records. ecfr.gov
- Texas Department of Insurance, "Fully insured vs. self-insured." tdi.texas.gov
- Medicare.gov, "Mental health care (intensive outpatient program services)." medicare.gov
- CMS, "The Mental Health Parity and Addiction Equity Act (MHPAEA)." cms.gov
This script is general information, not legal or billing advice. Payer rules differ by plan and change; confirm with each plan and your contracts.
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