Make one worksheet for each facility and plan rather than asking only whether insurance is accepted. The governed core guide to opioid treatment in California can help you frame treatment questions, while Living Longer Recovery admissions guidance for call preparation, live-availability questions, fit review, and next steps can help you prepare for a separate facility conversation. Record the representative’s name, department, date, time, reference number, and exact wording beside every answer.
In the eligibility column, write the member name, plan name, member and group numbers, effective date, and whether the policy is active for the proposed date. Ask whether behavioral health or substance use benefits are handled by another company. If they are, obtain that company’s contact information and repeat the verification there. Active coverage is only the starting point, not a promise that a service or provider will be covered.
In the authorization column, ask whether prior authorization, pre-certification, a clinical review, or another approval process applies to the specific service being considered. Ask who submits the request, what information is required, when it must be submitted, and whether authorization has an effective period. Do not treat an authorization as a guarantee of payment. Note any conditions and ask what happens if the service changes or continues beyond the initial review period. Do not delay urgent medical help while making insurance calls. Call 911 for immediate danger; call, text, or chat 988 for crisis support.
- Eligibility: Is the policy active, and who administers substance use benefits?
- Authorization: Is advance review required, who submits it, and what is the reference number?
- Provider status: Is the legal entity and exact address in network for this plan and service?