Addiction Treatment Service Reimbursement: Importance of Eligibility and Benefit (E&B) Verification

Physician holding clip board and pen while talking to a patientEach day, brave individuals make the decision to seek addiction treatment services. The one thing they don’t choose is a complicated insurance verification, eligibility and pre-authorization  process.

Addiction treatment is tough enough, and navigating the complexity of insurance coverage doesn’t help, which is why one of the most important parts of healthcare is Eligibility and Benefit verification.

What is Eligibility and Benefit (E&B) Verification?

Eligibility and Benefit (E&B) verification is a two-part process where providers go over aspects of a patient’s insurance coverage.

  • Eligibility: The first part of the process determines if a patient has insurance coverage and if the treatment provider is in-network within the patient’s insurance plan.
  • Benefits: The second part of the process goes over the details of the insurance plan concerning their treatment including coverage, copayments and deductibles, and pre-authorization requirements.

Why is E&B Verification Important for Addiction Treatment Service Reimbursement?

E&B verification is one of the most crucial aspects of healthcare that directly impacts patients and healthcare providers. For addiction treatment services, this step is especially important because while more treatment options are starting to get reimbursed, coverage can be overlooked or missed.

Why it Helps Patients

E&B verification does a lot to improve patient care and patient payments, more than providers realize. Because of E&B verification, patients:

  1. Get the care they need. When patients know they are covered and insured to move forward with treatment options, the chances of health outcomes improving go up.
  2. Find additional coverage. There may be additional coverage options patients aren’t aware of that’s covered, saving them money if they’re already pursuing this option. If not, they may opt to use this benefit, improving their health outcomes even more.
  3. Expect fewer surprise bills. E&B verification squares away what’s covered and what isn’t, so patients aren’t lost on what they owe.
  4. Get a better experience. A smooth patient payment process is a great way to keep patients happy and eager to recommend your services.

Why it Helps Providers

While E&B verification is an essential aspect of the healthcare system, the benefits aren’t just limited to patients. E&B verification allows providers to:

  1. Ensure reimbursement. Patients are verified up front helps a provider avoid treating uninsured patients, which puts them in a tough financial position.
  2. Reduce readmissions. Returning patients is never the goal, especially when it comes to addiction treatment. Maximizing treatment options is ideal for the best result: becoming sober.
  3. Improve health outcomes. Providers find out everything that’s covered so the patient can have the best treatment plan possible, focus on recovery, and achieve better health outcomes.
  4. Accurately claim submissions. Insurance gets the vital information they need to avoid error-free claims, leading to faster processing and less denials.
  5. Bill transparently. Knowing benefit details allows providers to give patients a heads up on out-of-pocket costs, avoiding unexpected bills later.

One of the hurdles patients face as they overcome addiction doesn’t have to be insurance eligibility and benefits. Incorporating E&B verification as part of the treatment process can ensure the best path to recovery for patients and better processes for the provider.

Contact us to see how we can help you integrate E&B verification into your revenue cycle.

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