Verification of Benefits to determine the payment structure of the insurance plan. We take the time to phone every family and explain the terms of their insurance policy, and the likelihood and possible length of coverage they can expect. We believe it’s better to educate a family in advance to the fact that most insurance plans will cover only a certain amount of treatment. We help manage a family’s expectations around insurance through a compassionate, yet frank discussion.

Information Interview/Exchange to gather information towards meeting insurance medical necessity criteria. We will compile information from a family directly, as well as information received by the treatment program, in order to build a case for medical necessity. We do not require that the treatment program play middle man.

Pre Authorization with the insurance company. Here is where we are the experts. We know what information to gather. We know what order to present the information, what tone of voice to use, and even what day of the week is best to call. We call them the tricks of the trade!

Utilization Review ongoing. Here we use our ongoing knowledge and “tricks of the trade” to extend the authorization as long as we are able.

Claims Submission. Utilizing a medical billing clearinghouse we submit “clean claims” electronically to insurance carriers to achieve the fastest possible turnaround time.

Medical Records/Document Follow Up. We manage the pesky task of pulling medical records for insurance companies.

Appeals. Nearly every family will face a denial at some point during residential treatment. We phone every family to talk through their options and support them with an appeal if they choose.

We provide referrals to attorneys when needed.

If a plan is self-insured, we will support policy holders in approaching their employer and requesting support to gain more coverage when appropriate.