Overview
A common question is whether a Verification of Benefits (VOB) can tell you if a patient's insurance policy is in-network or out-of-network with your facility. The short answer is: an Instant VOB cannot confirm this. Understanding the difference between an Instant VOB and a Full (Call-In) VOB is essential for correctly determining network status.
Key Concepts
Instant VOB: An electronic benefits verification that pulls benefit data (deductibles, coinsurance, copays, out-of-pocket maximums, etc.) from the payer via a clearinghouse. It does not confirm whether your specific facility participates in the patient's network.
Full VOB (Call-In VOB): A manual benefits verification completed by a staff member who calls the insurance carrier directly. This is the only VOB method that can confirm whether your facility is in-network or out-of-network with the payer.
Program Network Status: A field on the Full VOB form where staff record the payer's confirmed answer regarding the facility's network participation.
Network Participation (Internal Knowledge): Whether your facility is contracted with a specific payer is information your facility or operator already knows — it is not returned by the clearinghouse in an Instant VOB response.
How It Works
What an Instant VOB does and does not show:
When you run an Instant VOB, Dazos displays two sections — Coverage Information – In Network and Coverage Information – Out of Network. These sections show the benefit details (such as deductible amounts, coinsurance percentages, and out-of-pocket maximums) for each coverage tier as returned by the clearinghouse.
Important: These sections do not tell you whether your facility is actually in-network or out-of-network with the patient's payer. That determination requires knowledge of your facility's payer contracts — information the clearinghouse does not provide.
How to confirm network status with a Full VOB:
To confirm whether your facility is in-network or out-of-network with a patient's insurance carrier, a staff member must complete a Full (Call-In) VOB by contacting the insurance carrier directly by phone. During the call, the payer will confirm the facility's network participation status. The staff member then records the payer's response in the Program Network Status field on the Full VOB form in Dazos CRM.
Important Notes
⚠️ Do not rely on an Instant VOB to determine network status. The presence of in-network and out-of-network benefit sections in an Instant VOB does not indicate which tier applies to your facility — it simply shows the benefit breakdown for both scenarios as returned electronically by the payer.
✅ Best Practice: If confirming network participation is required as part of your intake workflow, always complete a Full VOB by calling the insurance carrier and document the result in the Program Network Status field on the Full VOB form.
💡 Tip: Your facility's network participation status with each payer is internal knowledge that your organization should maintain independently. If you are unsure whether your facility is contracted with a specific payer, check with your contracting or billing team before or in addition to completing a Full VOB.