Your Insurance Coverage
At Growth Extended, our goal is to provide the highest quality care for adolescents and young adults struggling with mood disorders, addictions, eating disorders, trauma, anxiety and co-occurring disorders. We take seriously our commitment to holistic intervention designed to treat and heal the underlying causes of your impairment. We are dedicated to aiding you to live a healthy life free from the distractions of addiction. We have become known in the industry for consistently providing the smoothest transition from the initial inquiry call into treatment. We do this by anticipating what the barriers to treatment may be. Funding is often a large barrier to treatment because intensive treatment that has lasting impact can be expensive. At Growth Extended however, our primary concern is not on getting you buried in debt, rather our team remembers why we delved into this business initially; to aid hurting persons and help equip them with the tools they will need to move forward in their healing journey. We never forget that and we never allow money to impede treatment.
Currently, Growth Extended has profiles with most major insurance companies to further assist in removing the barrier of funding for treatment. Meaning, we have agreements that allow us to accept insurance payment as the funding source for treatment in our various programs, residential, partial hospitalization and intensive outpatient programs.Insurance companies that we partner with include:
- UBH / Optum
- BlueCross BlueShield (BCBS)
- Com Psych
- Magellan Health
- Mental Health Network (MHN)
- Value Options
Being able to fund treatment with your insurance is a convenient way to obtain assistance with managing the cost of treatment. We also offer financial education and explanation of benefits once the insurance information has been obtained. Any details regarding fees and payment options will be discussed and counsel can be provided regarding how to manage the cost of treatment. Moreover, we can facilitate outside financing via loans with affordable repayment options in the event insurance is not suitable.
Steps in Understanding the Insurance Process
Our admission process includes an examination of the financial commitment being embarked upon so that there are no “surprises” upon admission. We ensure that prior to intake you understand fully your insurance benefit coverage and any obligations that are required of you. Here are some detailed descriptions of the admissions process to further assist you in understanding the financial component of treatment:
Benefits Verification of Insurance
- Once you decide to call us, you will be greeted by a caring concerned Admissions Specialist (if you are lucky you will get an opportunity to speak with Terrence, our Admissions Manager) and we will provide you will all of the clarification needed surrounding a potential intake.
- Depending upon how soon you would like to obtain treatment, we will discuss with you the first step in preparing for treatment, completing a Benefits Verification of Insurance.
- In order to complete the Benefits Verification, you will be asked to provide various forms of identification so that we may contact your insurance for you and ascertain the coverage level that is available on your policy. Coverage level is not a guarantee of payment. Meaning, even though you have the coverage level, we will still need to get your insurance to authorize you to utilize said coverage.
- Your admissions specialist will contact you within 24 hours to provide you with the results of the verification. General details will be provided to you including what the admissions fee will be (if any).
- If you need further clarification, we certainly recommend that you contact your insurance provider directly. This quote of benefits is NOT a guarantee of coverage.
- After your Admissions Specialist has communicated the benefits with you, if you would like, you can speak with an Accounting Specialist directly for further clarification. We will provide a comprehensive explanation of your benefit package including your deductible, your out of pocket maximum, your daily limit, etc. It is important to us that you are fully aware of the benefit coverage that you have.
- You are free to decide if you would like to move forward with an admission at this point.
Insurance Authorization Process
- The second step to utilizing your insurance coverage to aid in the cost of treatment is to complete a Pre-Admission Assessment. This assessment is completed prior to admission and consists of a comprehensive examination of social, educational, familial, legal, components surrounding the history of the potential client. Additional aspects include presenting problem, strengths, weaknesses, treatment focus options and, the most important historical data, prior treatments. Having tried lower levels of care will aid in obtaining authorization at higher levels of care. Your insurance includes having tried lower levels of care as one of the criteria to help justify the need for higher level authorization. This too, is not a guarantee. We have seen insurance authorize persons with no lower levels of care at residential, so it is important to allow our doctors to review your assessment and provide you with a determination.
- In order to quality for insurance coverage, you must meet medical necessity criteria. This criteria varies based upon insurance provider.
- No authorization to utilize benefits will be given by your insurance company prior to admission. Authorization is only given following an assessment by the facility.
- In order to obtain authorization for treatment, someone from the facility must contact the insurance company directly to request the authorization.
- At Growth Extended, we have a Utilization Review Department that is solely focused on working with your insurance provider to help them understand your case. The utilization review specialist will converse with the assigned insurance case manager to obtain your initial authorization upon admission.
- And although we recommend a minimum of 45 days, your insurance provider only provides authorization for 5-7 days at a time. Once the initial 5-7 days expires, we will call the insurance and advocate for an additional 5-7 days. This process continues as long as you continue to meet medical necessity criteria.
- In rare cases the insurance case manager could decide that treatment is no longer medically necessary and will not continue to authorize payment for your stay at the current level. Do not be alarmed. In the event that this happens, we will communicate with you as soon as the insurance alerts us that there is a possibility that insurance coverage may be disrupted.
- You always have options and conducting a doctor level review will sometimes be sufficient to continue at the current level of care.
- If the insurance doctor however, differs from our doctor at Growth Extended in their depiction of the case and the insurance doctor feels that the current level of care is no longer medically necessary, you may receive a denial letter in the mail.
- You still have options, including appealing the denial or accepting a lower level of care recommendation, which is typically what the insurance will recommend.
- Growth Extended will remain in good communication with you so that you are aware and understand the process during the 3-5 day waiting period that appeals can last.