Single Child Insurance Policy for Mental Health — Insurance
During the time of November 1st through typically January 15th is open enrollment in many states across the country. You could possibly have an opportunity to purchase a single policy medical plan for your child or change the current one you have to one that would offer more benefits for therapeutic boarding schools or residential treatment centers. These are usually PPO policies.
Insurance companies such as Cigna, Aetna, Blue Cross Blue Shield and United Healthcare usually offer some type of single case PPO plan. It’s important to apply during their open enrollment.
Insurance Assistance
Need help filing your medical insurance?
Denials Management, Inc. or SJ Health Insurance Advocates are insurance advocates that can help you fully investigate your potential insurance options. Contact them directly for more information.
PPO Insurance Benefits
Depending on your insurance policy, is where you answer starts. Most PPO (Preferred Provider Organization) policies will offer out-of-network benefits after you have meet an out-of-network deductible. These providers include (but not limited to): Aetna, Cigna, United Healthcare and (UMR), and Blue Cross Blue Shield.
If you decide to stay in-network with your PPO provider, you will have more financial coverage. The one struggle parents run into is they are typically shorter-term facilities and the more concerning issue is the teenager has to be a willing participant. In other words, they don’t permit your teen to be transported to the program.
When considering private therapeutic boarding schools, PPO insurance out-of-network benefits will typically cover a portion of the clinical component of the program, however you will still have out-of-pocket costs. These schools and programs will offer you a courtesy verification of benefits (VOB) to give you a strong determination of what is covered for you. By having the program complete the VOB for you, rather than doing this yourself, you will get a more accurate result — since they have a better understanding of their billing codes.
There are some therapeutic boarding schools that will file your insurance for you and deduct it from your invoices, while other programs will give you what they call super-bills. With these super-bill invoices, you will have to file them with your provider and wait for your reimbursement.
Medicaid, HMO or Tricare Insurance
For families that have Medicaid, HMO or a Tricare health insurance policy, and you would like your medical benefits to cover your child’s behavioral modification program — please contact the number on your insurance card and ask them for residential treatment centers in your network. This way you will have coverage. Self-pay programs start at about $7000 per month and up. They usually will only accept PPO insurance policies.
Tricare may cover for some private programs. You can ask the program you are considering if they accept your Tricare policy, by running a verification of benefits (VOB).
HMO’s offer single case pay agreements (SCA).
A Single Case Agreement (SCA) is a contract between an insurance company and an out-of-network provider for a specific patient, so that the patient can see that provider using their in-network benefits (i.e., the patient will only have to pay their routine in-network co-pays for sessions after meeting their in-network deductible (if any).
