Verification of Benefits (“VOB”) occurs nearly daily, and the practice relies on the information provided by the payer. Yet, if the payer gets it wrong, can the practice still force reliance on the misinformation? The court has said it depends on the context of the words used during the call. In the case brought by Desert Cove Recovery, LLC, they attempted to bring a class action against United Behavioral Health. While the court did not certify the class action, citing a lack of commonality, this case has very important information.
Arguments
Desert Cove argued the payer formed a contract when United Behavioral Health verified benefits or obtained preauthorization for the provider to treat the beneficiary. They also argued the payer agreed to reimburse the provider for medically necessary services but then denied coverage based on the level of care coverage decision guidelines set by the payer.
The Outcome and Take-a-ways
The court did not certify this case as a class action, which was the primary reason for bringing it forward. But what the court said, in its opinion, is critical information for any practice. Document call notes with specific details in the patient’s accounts. The court said in this case that a fact finder would need to look at the specific call to determine if there was an intent to transact.
In the end, the court said there was no class to bring forward a class action. It is not off the table to challenge VOB on a call when documented, and there is certainty of meeting medical requirements and payment. This will all boil down to taking excellent call notes.
