HMO, PPO, EPO, In-Network, Out-Of-Network, Single-Case Agreement, Out-Of- Pocket Maximum—it’s enough to make your head spin. You call us because your family needs help. The last thing on your mind is insurance industry alphabet soup. You don’t want to spend your time and energy figuring out what type of policy you have, whether you’re covered, or what you have to do to get the ball rolling.
We help with all that.
We untangle the complicated web of health insurance and translate policy jargon into plain language.
We talk to your insurance provider and advocate for you to maximize your benefits at every level of care. Whether your teen needs Residential Treatment (RTC), Partial Hospitalization Treatment (PHP), Intensive Outpatient Treatment (IOP), or Outpatient Treatment (OP), we find out what your policy includes.
During our initial phone call, we ask for your policy details and get on the phone right away with your provider. We get all the information we need to move forward and start the pre-admission process. We tell you if your policy covers mental health or substance abuse issues. In most cases, we can easily confirm your level of coverage and give you an estimate on your potential out-of-pocket costs.
We have regular out-of-network relationships with the following insurance providers:
- Blue Cross/Blue Shield
- Health Net
- Optum/United Healthcare
- Oxford Health Plans
- United/United Behavioral Health
- Value Options
If you call us during regular business hours (Monday-Friday between 9:00 am and 5:00 pm) and we’re able to contact your provider right away, we typically have answers for you by the end of the day, if not by the end of the conversation. If you call us over the weekend or after regular business hours, we start the process first thing on the next business day.
If your insurance policy doesn’t cover mental health or substance abuse disorders, don’t panic. We can attempt to negotiate what’s called a Single Case Agreement (SCA) with your insurance provider. SCAs are contracts made on a case-by-case basis so that out-of-network providers can work with your insurance company on an in-network basis.
Please click here for our glossary of common insurance terms related to behavioral, emotional, and addiction disorders.