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One of the more frequent errors that the VOB Team comes across when handling
VOBs is the facility providing the wrong insurance company. Often this is due to
relying on seeing an insurance logo elsewhere on the card rather than focusing on
the insurance company or third-party administered name found on the card.
More than 90% of time, the name of the insurance company or administrator will
be found on the top left or top center of the card. When you see insurance
company logos elsewhere on the card, such as on the bottom 3rd of the card or on
the back of the card that does not match the insurance name on the top, the
insurance is often using the insurance company’s network, but is not actually a
policy of that insurance company.
Determining who the insurance company is prior to submitting a VOB request is
extremely important to the process. Having the wrong company leads to delays in
getting quick verify information back and running the VOB. Without the correct
insurance company, we cannot search the policy and may not have the correct
phone information.
Third-Party and Small Group Plans
Aetna, Cigna and United are typically the three insurance companies we see most
often that are improperly identified. These three insurance companies partner with
3rd party administered plans and small group plans to utilize their networks but are
not their direct policies.
Another type of policy that while we can get basic online portal information for, are
run by 3rd parties are individual offices are labor union policies. These policies often
require very specific phone numbers to contact them and sometimes have policies
and terms that are very different from traditional plans. Most of the labor union
policies we see are BlueCross BlueShield plans. If your facility has a policy that you
know is from a labor union, we need the specific phone numbers found on the back
of the insurance card. Without those numbers, its very difficult to track down
specific contact information for their office.
HMOs, EPOs, Medicare and Medicaid
Very often, you will be able to identify a policy that is an HMO, EPO or through
Medicare/Medicaid by looking at the card. For HMOs and EPOs, look for those
acronyms on the card or from key words such as ‘Exclusive’ or ‘In-Network Only’.
Medicare policies will often have the words ‘Medicare’ listed on the back of the card.
For Blues and United policies, Medicare policies will sometimes have a letter at the
end of the ID number. Similar wording can often be found on Medicaid cards as
well as wording that references that it is a state program. For California facilities,
Medi-Cal is California Medicaid.
Phone Numbers and Best Practice Providing Card Images
Getting the correct phone number for a specific plan is critical to our running a VOB.
It is best practice to provide us with the provider number or behavioral health
number listed on the back of the card. If the card has a behavioral health number
as well as a provider number, it is most helpful to provide both numbers. Finally,
the most helpful way to provide us with the correct information is to attach images
of the front and back of the card to your request email. We can significantly reduce
delays in calling on a policy when we have the images and can trouble-shoot an
issue.
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