Verification of benefits for behavioral health, with script
Checking benefits before the first session prevents surprise bills and denied claims. A consistent process keeps each check short once your team knows it.
Eligibility check vs benefits verification
A portal check is often enough for active status. Call the payer for the rest.
What are the ways to verify insurance benefits?
| Method | What it shows | When to use it |
|---|---|---|
| Payer portal | Whether the plan is active, the plan name and the effective date | First, on every check |
| Clearinghouse eligibility check | Whether the plan is active and the effective date | First, in place of the portal check |
| Call to the payer | Mental health carve-outs, costs per service code, visit limits and prior authorization rules | When the portal or clearinghouse leaves out behavioral health details |
What do you need before you start?
You need the client's name, date of birth and member ID, the payer's phone number or portal login, your practice's NPI and tax ID, and the service codes you will bill.
- Client name, date of birth and member ID
- Payer name and phone number or portal login
- Your practice's NPI and tax ID
- The service codes you will bill, such as 90791, 90837 and 90834
Verification of benefits process, step by step
Six steps take you from a portal check to a recheck at the start of each plan year. A trained assistant can run this verification of benefits process for you; compare rates on pricing or estimate cost with the VA vs in-house calculator.
Step 1: Check the portal first
Look up eligibility in the payer portal or clearinghouse. Confirm the plan is active and note the effective date.
Step 2: Call if details are missing
Portals do not always show behavioral health benefits. Call when you need to confirm coverage for therapy or limits.
Step 3: Ask the right questions
Use this script:
- Is the member active today, and what is the plan name?
- Does the plan cover outpatient mental health, and is it carved out to another company?
- What is the copay or coinsurance for each service code?
- What is the deductible, and how much has been met?
- Is there an out-of-pocket maximum and how much has been met?
- Is there a limit on the number of visits?
- Is prior authorization required?
- Does the plan cover telehealth, and which place of service code is required?
- Am I in network, and what is the effective date of my contract?
- Is there another plan that pays first?
- What is the reference number for this call?
Step 4: Record everything
Write the date, time, representative name and reference number. Save the results in the client record.
Step 5: Tell the client
Explain what they will owe in plain language before the first session. Offer a Good Faith Estimate if they will pay out of pocket.
Step 6: Recheck
Verify again at the start of each plan year and whenever the client reports a change.
Benefit verification checklist
Capture the same fields on every check, from the portal or the payer call:
- Active status, plan name and effective date
- Outpatient mental health coverage, and any carve-out to another company
- Copay or coinsurance for each service code
- Deductible and how much has been met
- Out-of-pocket maximum and how much has been met
- Visit limits
- Whether prior authorization is required
- Telehealth coverage and the place of service code required
- Your network status and contract effective date
- Any other plan that pays first
- Date, time, representative name and reference number
What problems come up most often?
The most common problems are mental health benefits managed by a separate company, Medicaid managed care plans with different member IDs, and secondary insurance the client did not report.
- Mental health benefits managed by a separate company
- Medicaid managed care plans with different member IDs
- Secondary insurance not reported by the client
Key terms
- Eligibility check: confirming in the payer portal or a clearinghouse that a client's plan is active, and noting the effective date.
- Verification of benefits (VOB): confirming a client's coverage, costs and rules with the payer before care starts.
- Copay: a fixed amount the client pays for each visit.
- Coinsurance: a percentage of the allowed amount the client pays, usually after the deductible is met.
- Deductible: the amount the client pays each plan year before the plan starts paying its share.
- Out-of-pocket maximum: the most the client pays in a plan year for covered in-network care.
- Carve-out: when a health plan hands its mental health benefits to a separate company to manage.
- Reference number: the ID the payer gives for a call, so you can show what the representative confirmed.
Frequently asked questions
What is the verification of benefits process?
Check eligibility in the payer portal or a clearinghouse, call the payer for anything the portal leaves out, ask the same questions every time, record the representative's name and a reference number, explain costs to the client before the first session, and recheck at the start of each plan year.
Is a portal check enough?
Often for active status. Call for details like visit limits and authorizations.
What should you ask the payer on a benefits call?
Confirm active coverage, any mental health carve-out, copay or coinsurance for each service code, deductible and out-of-pocket amounts met, visit limits, prior authorization rules, telehealth coverage, network status and any other plan that pays first. Get a reference number for the call.
How early should we verify?
As soon as the client books, and at least two days before the session.
Can a virtual assistant verify insurance benefits?
Yes. A trained assistant can run each step above: the portal check, the payer call with the same questions every time, the record with the representative's name and reference number, and the cost explanation before the first session. See pricing for assistant rates.
Sources and last checked
Checked 2026-10-09. HIPAA requirements: HIPAA.gov (opens in a new tab). Confirm current payer portal steps and service codes with each payer. This is general information for practice operators, not legal, tax, financial or medical advice.
Related guides
- Prior authorization workflow for psychiatric medications
- What a virtual assistant can do for a therapy practice
- See all Second Desk guides
How Second Desk helps
Second Desk provides assistants trained to verify benefits for behavioral health, one of the tasks a virtual assistant can take on for a therapy practice. Compare rates on pricing, estimate cost with the VA vs in-house calculator, or meet a candidate.
Second Desk assistants are trained for behavioral health front offices. Our published rates are $14 per hour full time and $16 per hour part time.
Meet a candidate