How many days of the program will my insurance cover?
Each insurance company has their own set of criteria they use to determine length of stay. Please speak with your admissions counselor for specifics regarding your particular health plan and the average length of stay.
How does insurance authorization work?
Insurance authorization works the same way for all treatment centers and for all insurance companies. The insurance company will start the authorization on the day we ask for it. The insurance company typically authorizes 7 days at a time. We have seen them authorize less and more, but 7 is average. At the end of […]
Does Evolve offer flexible payment options?
We can be flexible when figuring out the best payment option for families. We do not want money to be a hindrance on someone’s ability to get their child the help they need. However, we cannot legally waive a copay or a deductible but we can work with a family on a payment plan.
What are Concurrent Reviews?
The concurrent review takes place while the patient is receiving care while admitted to a facility. The insurance company authorizes a set amount of days. At the end of this period, the therapist provides justification as to why the client needs to stay longer, and (hopefully) the insurance authorizes another chunk of time.This process continues […]
What is a COB?
Coordination of benefits (COB) applies to a person who is covered by more than one health plan. A COB identifies which insurance plan is “primary” and which insurance plan is “secondary”. There can only be ONE plan that is primary. Whichever subscriber’s birthday is first in the year will be the primary insurance. The COB […]
What is the difference between my deductible and out-of-pocket maximum?
In a health insurance plan, your deductible is the amount of money you need to spend before your insurance starts paying some of your health care expenses. The out-of-pocket maximum, on the other hand, is the most you’ll ever spend out of pocket in a given calendar year. Once you have completely met your out-of-pocket […]
What does Medical Necessity mean?
Medical necessity refers to a decision by your health plan that the treatment or procedure is necessary to maintain or restore your child’s mental health or to treat a diagnosed medical problem. In order to be covered under the health plan, a service must be considered medically necessary. Evolve has to prove that it is […]
When are Single Case Agreements granted by insurance companies?
Single Case Agreements are often granted when the individual is in need of specific treatment and no treatment center “In-network” on the insurance panel offers the specialized treatment, or one in-network is too far away or full. If one is granted, Evolve will work with the Insurance Company on the terms.
How do you know when someone needs an SCA?
Essentially, this is when an individual’s insurance policy does not have any out of network benefits and therefore, we need to request to use your in-network benefits.
What is a Single Case Agreement?
A Single Case Agreement allows an out-of-network provider to be considered “in-network” for a single patient/client (e.g single case). This means the client/family would only be responsible for copays and in-network deductibles which makes treatment more affordable. They only do this when there are no other open spots at in-network treatment centers in the family’s […]