We realize that for many families, paying for high-quality treatment can be an obstacle. Just as in any other field of health care, affording the best possible treatment can be challenging. Oftentimes, insurance companies favor low cost, contracted or in-network treatment options over higher quality, individualized and comprehensive programs. Unfortunately, this can result in teens receiving poor treatment that is both ineffective and can subsequently cost more in the long run as further treatment is needed.
At Muir Wood, we accept most insurance. We work with families on verifying their out-of-network benefits and call the insurance provider to authorize treatment. We also provide ongoing communication with the insurance provider (if necessary) to advocate on the patients and parents behalf.
Step One: Verification of Benefits
If families are interested in using their insurance to pay for treatment, the first step in this process is to verify insurance and ascertain whether there are out-of-network mental health and substance abuse benefits. Muir Wood works with insurances on an out-of-network basis only, and most PPO insurances have out-of-network benefits. Parents will need to provide Muir Wood with their insurance information (or send us a photocopy of the front and back of their insurance card). Our admissions team will confirm benefits, typically that same day.
Step Two: Determining Medical Necessity for a Residential Level of Care
Once we have determined if there are insurance benefits on an out-of-network basis, our licensed therapists will need to speak with the adolescent’s parents and/or referring professionals to determine if the adolescent meets clinical criteria for a residential level of care. This interview with parents and/or professionals allows our treatment team to determine not only if the adolescent will meet insurance criteria for a residential level of care, but also if the adolescent is best suited for Muir Wood.
Our Admissions Department will review the coverage levels quoted by your insurance provider including any deductibles (the amount you pay for health care services before your health insurance begins to pay) and any co-pay amounts (a fixed amount for health care service that is usually paid at the time you receive the service).
Step Three: Scheduling an Admission
If after speaking with our licensed therapists it is determined that the adolescent meets clinical criteria for a residential level of care, the Admissions Department will work closely with parents or referring professionals on scheduling an admission. This may include forwarding and assistance with the admissions application, scheduling an admission for the next available bed, or assisting the parents on how to intervene and best transport their son to treatment.
Many parents opt to pay for treatment out of pocket. That is, insurance providers are not contacted initially and parents pay for treatment services in full at the time of admission. Muir Wood assists parents in the provision of what is commonly referred to as a “super-bill” or itemized bill of services provided at the time of discharge. Parents can then submit this itemized claim to their insurance provider if they choose to do so. Muir Wood will provide parents with the itemized claim and help submit any paperwork required by the insurance provider at no cost.