Paying for Treatment
Understanding the financials of treatment can be difficult especially when you or your loved one is in crisis. It may also affect your decision on what level of care you feel you can afford. We do what we can to provide you with a verification of benefits by calling your insurance carrier and asking for the co-pay and/or co-insurance rates of all services provided by our treatment providers and facility costs, your current deductible, and out of pocket maximum costs for the remainder of the term of your insurance. However, this is only a courtesy and is not a guarantee of payment for services by your insurance company or that the information we received is fully accurate. It is always best to verify your benefits with your insurance directly and write down who you spoke with and get a reference number for the call. If what you were told is different than what your insurance will cover, then you often can make a case to get the benefit you were quoted.
We are Currently In-Network With
Johns Hopkins Employee Health
US Family Health Plan
Providing you with answers about your coverage:
At TBITC, we understand that you will have questions and we will do everything we can to be as transparent about your billing as possible. Every insurance company has different billing protocols and as a result you may see a variety of charges depending on your plan. Some plans have Per Diem coverage where all services are bundled into one charge for the day. Others require us to bill for each individual service. Some also require us to bill as some hospitals do where you will see a hospital or facility charge and then services for the individual provider for the same service (e.g. a bill for individual therapy may show for the same date under our facility charge and another for the specialist/therapist). We will do our best to communicate with you each step of the way what your insurance plan asks us to bill for so you have a reasonable understanding of what you will see in your Explanation of Benefits notices from your insurance company.
Consider these questions when discussing your coverage with us or any other program:
- Do you have a PPO, EPO, or HMO?
- What facilities are available in network?
- If the facilities that are in-network are too far away, what options do you have for using a program that is out-of-network and close by?
- Do you need a medical referral?
- Can you select an out-of-network provider or must you stay within the network?
- Are there exclusions for services (e.g. many plans do not provide nutrition coverage except for diabetes diagnosis. So ask if they cover eating disorder diagnoses. If not, do they cover any other medical diagnoses such as malnutrition?)
- If the facility is not in-network and other in-network programs are on a wait list or can’t accept me for some other reason (e.g. gender, age, disability access), can I request a “single case agreement” to be seen at a program not in-network at my in-network coverage rate, deductible, and co-pay?
- You can never ask too many questions of your insurance provider.
Dealing with hurdles
You have probably heard horror stories about being denied treatment for care, or not seen has “sick enough” for the level of care experts know you or your loved on needs. This is known as not meeting “medical necessity.”
We see this a lot where insurance denies the level of care an eating disorder treatment team concludes would be most reasonable to assist an individual in their recovery. Our team will go to bat for you and your loved one to get the level of care coverage recommended. We have years of expert experience fighting insurance companies using hard data about behaviors, medical need, psychological and psychiatric evaluation tools, and comprehensive assessment tools to make our case. Our licensed therapists, registered dietitians, and psychiatrists and medical providers fight for every day of care we can get for you and your loved one.
If insurance drops coverage for one level of care, we can keep continuity of care in our system as we have residential, partial hospital (with and without transitional living options), and intensive outpatient programs so you won’t just drop down to care.
Getting care even when finances are a problem
If your insurance does not cover services at TBITC, we have self-pay rates that we can negotiate with you if you have no health insurance, are denied coverage, or lack eating disorder treatment coverage. We will do the best we can to help with payment plans or an application for charity for those who need help with high co-pays and deductibles as well. For more information on this process please contact Billing Specialist Mary Brasch at (240) 722-1014.