Adolescent Mental Health Treatment Covered By Insurance

With the increase in mental health awareness over the last decade, the insurance industry has made significant moves to create a clearer path for benefits, to help parents struggling with teens in crisis. These changes have helped to create a much needed pathway towards understanding treatment coverage, and is beginning to be used more readily by professionals and patients alike.  For young adults caught in the grip of mental or behavioral health trauma, these new changes can mean the difference between recovery and an endless struggle.

Most of the top adolescent mental health treatment programs are designated as “out-of-network treatment providers” by the major healthcare insurance plans, such as CignaAetnaUnitedHealthcareUHC of CaliforniaHealthNet, and Pacific Source.

The top teen treatment programs are often set up to be designated as “out of network treatment providers” so they can accept and have direct access, to most major insurance plans.  They do this as a means of helping parents cover the high cost of mental health treatment. These top programs understand the immense financial challenges parents face when paying for outpatient and/or inpatient treatment. In most cases, using insurance benefits is the only way families can afford treatment.

The best adolescent treatment providers work hard to lighten the family’s financial burden without reducing care or restricting treatment. Because they accept major insurance plans,successful treatment programs are able to reduce the out of pocket cost parents pay for mental health treatment. Sadly, for a troubled teen addicted to opioids or other harmful substances, a good healthcare insurance plan can often mean the difference between life and death.

Today, most behavioral health practitioners and mental health treatment providers go to the ends of the earth to help parents lower the cost of therapeutic treatment. They accomplish this by  encouraging their admissions team to work with both the family and the insurance company to make sure parents are able to take advantage of every possible benefit. The cost of adolescent mental health treatment is largely out of reach for most families, so to get help from the admissions department is an invaluable benefit.

Finding A Treatment Provider Who Accepts Your Insurance - Verification Of Benefits

To get started, parents are typically asked to submit their insurance information to the programs billing department. The purpose of submitting insurance information is for the standard process referred to as “Verification of Benefits.”

Once the insurance information is received from the parents, the program and the insurance company work together to verify coverage and benefits. It is critical that this process begins immediately, because unless a parent has a “verification of benefits” completed, it’s difficult to navigate and complete the admissions process.

The program’s insurance billing department will get in contact with the parent’s insurance provider to get a detailed explanation of the mental health and chemical dependency benefits within their policy. This explanation of benefits is made available to the parent by the admissions counselor generally within a few hours.

For the VOB the following information is gathered:

  • Individual Out of Network Deductible and what has been applied to date
  • Individual Out of Network Out of Pocket Maximum and what has been applied to date
  • Whether there are Annual or lifetime benefits
  • Co-Insurance % after deductible is met
  • Coverages available (RTC, PHP, IOP, GOP)
  • Whether there is a waiting period for preexisting conditions
  • Insurance Verification Form

Many insurance policies require a pre-authorization. Pre-authorization is a preapproval from the insurance provider to provide treatment services to your child. At Turning Winds our admissions and treatment team will do all they can to complete the pre-authorization process for you.

Adolescent Behavioral Health Services Are Usually Covered By Insurance Plans

By law, all behavioral health plans must cover:

  • Behavioral health treatment, substance abuse treatment, individual and group counseling, etc.
  • Acute mental health inpatient services
  • Inpatient care in an approved facility
  • Intensive Outpatient Program (IOP) care
  • Medical detox, including medications
  • Co-occurring mental health conditions

Each parent’s specific behavioral healthcare benefits vary depending upon what State they reside in, their employer’s benefits, and the healthcare service providers in their local area. Cadillac healthcare plans sometimes cover additional treatment options such as:

  • Longer Stays at Residential Treatment Facilities
  • Partial Hospitalization Program
  • Intensive Outpatient Treatment
  • Inpatient care in an approved facility
  • Outpatient care with an approved provider
  • Medical detox, including medications
  • Co-occurring mental health conditions
  • Aftercare and other follow-up counseling services
  • Maintenance addiction medication

To make sure you receive the optimal care for your child, talk to our professional staff at Turning Winds to determine what insurance benefits may be available to assist you. Helping a child recover from mental or behavioral health disorders can be a very emotional and frustrating time; let us help you through the process.  Call 800-845-1380 today for help. 

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