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What to Expect: Insurance & Paying for Treatment

for Adult Patients

When you are working towards recovery, you shouldn’t have to worry about insurance coverage or how you will pay for treatment. Your top priority is finding the best eating disorder treatment center possible.
 

The insurance business can be complicated and it can take time to get the answers you want. We’d like to take some of the burden off your shoulders by doing everything we can to make the insurance and payment process as smooth as possible.

Providing you with guidance and care

At Eating Recovery Center, our staff will assist you in finding the information you need by doing the following:

 
  • Serving as a liaison between you and your insurance company
  • Providing guidance and communicating updates to you regularly
  • Answering your questions
  • Following the insurance claim process with integrity
  • Explaining costs and coverage throughout the entire process

When you are choosing an eating disorder treatment center, we recommend that you partner with a provider who is trustworthy and who communicates regularly and openly with you regarding finances.

Helping you each step of the way

If you are interested in learning more about the financial process at ERC, simply call us. A Masters-level clinician will answer your questions and take your insurance information if you’d like. With your approval, our insurance verification experts can then contact your insurance company for you, and communicate back to you in easy-to-understand terms exactly what your coverage includes and how you can get care.
 
Please know that if you choose to call us with any questions regarding insurance and payment, this in no way binds you to come here for treatment. 

Consider these questions

You can also contact your insurance customer service representative directly, in order to better understand your insurance policy and mental health benefits. When you call your insurance company, consider the following questions:

 
  • Do you have a PPO, EPO, or HMO?
  • What care facilities are available in your area? (Unfortunately, even if your treatment provider recommends that you enter a program for eating disorder treatment, this type of treatment may not be available in your area).
  • Are there travel restrictions limiting you to certain facilities for care?
  • Does your insurance customer service rep understand the difference between eating disorder care vs. general mental health care?
  • Can you select an out-of-network provider or must you stay within the network?
  • Are there financial risks associated with utilizing an out-of-network provider or a provider that represents as working with your insurance versus contracting with your insurance?
  • Are there exclusions (care not covered by your policy)?

Our advice to you is this: you can never ask too many questions when it comes to insurance and paying for treatment.

Dealing with hurdles

You have probably heard stories about individuals being denied treatment or may have even faced insurance challenges yourself in the past.
 
One of the hurdles that some people face with insurance coverage is known as “utilization management.” Here’s how it works: your plan offers you specific covered benefits, but these services must be shown to be medically necessary. Here are some scenarios that come up from time to time:

 
  • Your treatment provider recommends residential treatment but your insurance plan says that you don’t meet the “medically necessary guidelines” anymore. In this situation, your case will go under utilization review.
  • You may understand that you need approximately six weeks of care, but your insurance company is saying that they need progress updates every few days in order for you to stay in care with continued authorization.

If this occurs, our exceptional utilization review teams will do the work for you. They can deliver (when necessary) high-quality, excellent clinical data to your insurance provider in support of your continued stay — so that you can continue working toward recovery. Our licensed clinicians work closely with insurance providers every day to communicate the most important details to them and to show them your progress. If needed, our medical doctors are also available to help get expedited appeals to your insurance company.
 
When you come to ERC, we will educate you on every aspect of this process and will update you frequently. This process is so important. Often, these steps can make the difference between getting substandard care and getting high-quality care. Please know that we will reach out to you to discuss any significant issues that may come up.

Getting the best care possible

As you prepare to enter treatment, learn as much as you can ahead of time so that you will know exactly what your coverage includes and exactly what you will be expected to pay out-of-pocket.
 
Please know that we do not work directly with Medicare, Medicaid or Tricare. If you have Medicaid administered by a third-party Managed Care Organization (MCO), there are occasional exceptions granted so that you can work with ERC. To learn more, please reach out to your clinical contact with Medicaid to see if your Medicaid is associated with an MCO. If the answer is yes, please encourage them to contact an ERC clinical assessment specialist to discuss further.
 
And, if your insurance does not cover care at ERC, we will work with you and your family to establish self-pay rates. We will do our best to find a financial solution that allows you to get the care you need and deserve. This option is helpful if you are experiencing one of the following situations:

  • Don’t have health insurance
  • Lack eating disorder treatment benefits
  • Have high co-pays or deductibles
  • Are denied coverage by your insurance provider
  • Have a limited number of treatment days

In some cases, you will be able to appeal to your insurance company for reimbursement of some of the fees.

Starting care

Before you start treatment at ERC, we will send you admissions documents that summarize your insurance benefits. These documents will also list any balances due along with deductible and co-insurance information. We will also ask you for permission to bill your insurance carrier on your behalf. When you arrive for treatment, we will be here to welcome you and will answer any additional questions that you have.
 
We want you to have the best care and we want it to be affordable and accessible. Our goal is to be here for you, to encourage and support you and to work with you to deliver the information that your insurance company needs. We consider ourselves experts at the insurance and financial process and we look forward to working with you here at ERC.

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Eating Recovery Center is accredited through the Joint Commission. This organization seeks to enhance the lives of the persons served in healthcare settings through a consultative accreditation process emphasizing quality, value and optimal outcomes of services.

Organizations that earn the Gold Seal of Approval™ have met or exceeded The Joint Commission’s rigorous performance standards to obtain this distinctive and internationally recognized accreditation. Learn more about this accreditation here.

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