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Insurance Companies
What to expect
from your insurance?
It is very important for patients to understand what to expect from
their insurance carrier prior to and upon admission.
For many patients, accessing insurance benefits is the most
frustrating aspect of the admission process. At Wekiva Springs, we
will do everything we can do to assist the patient in securing
appropriate benefits for the services we provide. We will:
- Contact the insurance provider to verify benefits
- Complete any necessary pre-certification process required by
your insurance company.
- File all of the appropriate documentation to claim payment for
your care
- Work with our physicians and medical staff to make phone calls
on your behalf to discuss your diagnosis.
Unfortunately, we are aware of many instances where the
insurance benefits that are offered through the employer or self
insured policy may not cover all of the services offered at Wekiva
Springs. Our treatment team will make specific recommendations for
your care based on our 33 years of healthcare experience, not your
insurance benefit. We encourage patients to not rely on insurance
benefits to determine the best care.
Like any other hospital or physician’s office, the patient is
ultimately responsible for the costs of treatment at Wekiva
Springs.
Many patients see treatment as a significant investment in their
future and make the decision to self-pay. This allows the ultimate
flexibility in accessing the most appropriate programs for the
patient and her family.
Frequently Asked Questions Related to Financial
Services and Insurance
- My insurance says I have 30
inpatient days and yet the admissions staff says I do not have a
residential benefit. What does that mean?
Insurance is a purchased service. This means that you or your
employer purchased a selective set of services from the insurance
company to manage the cost of your care. In this case you or your
employer may have purchased inpatient and outpatient services but
not residential services, which would fall under a different type
of benefit. You may want to discuss this with your insurance broker
or human resources department.
- What can I do if my insurance
company says that there is no benefit or my benefit is
exhausted?
You can contact your insurance company or human resources
department and request that they flex your benefit. This means that
they will trade one service benefit for another. For example, an
insurance company may trade an inpatient day for a residential
day.
- I don’t understand. I
have good benefits…why isn’t this covered?
Insurance companies ask two questions when a call is made to access
services:
One: Is there an available benefit for this type of service and
Two: Is it medically necessary?
If the answer to either of these questions is “no” then
the insurance company will usually deny payment. If denied, you may
contact your insurance company and request an appeal to their
decision. The number to call is on your insurance card or is
located on your member rights and responsibilities brochure
supplied to you by your employer or insurance company.
For more information on what your insurance company determines is
medically necessary, please go to the website on your insurance
card. Please keep in mind, they will differientiate between and
mental health and substance abuse conditions. Be sure to check
under each area.
- What constitutes a medical
necessity? Who determines if my treatment is medically
necessary?
Your insurance company looks at this term globally whereas Wekiva
Springs looks at it from an individual stand-point. Your
insurance company has its own clinical criteria for inpatient,
residential and outpatient services. This is a guide used by your
insurance to define medical necessity based on diagnosis. At Wekiva
Springs each patient has a treatment team which takes a holistic
approach to your care. It is possible that you do not meet the
global insurance medical necessity criteria; however, due to your
individual situation your treatment team will recommend specific
services.
- My insurance card says one
insurance but when I call, it’s a different number for mental
health.
Health Insurance providers often use another contracted company for
mental health and substance abuse services. These companies, known
as carve-outs, are behavioral health organizations (BHO) contracted
with the health insurance company to manage your mental health
services.
- What does Wekiva Springs do to
assist me with my insurance?
Wekiva Springs has contracted with major insurance companies in the
state of Florida and some national and international insurance
plans. By contracting with your insurance company the patient will
receive the benefit of using the in-network benefit of their
policy. Wekiva Springs is contracted with major insurance companies
to include Medicare, Federal, State and Commercial members.
If your health plan is not contracted, our admissions staff will
work diligently to obtain a single case agreement if a benefit is
available.
- What is a single case
agreement?
A single case agreement is a contract between your insurance
company and Wekiva Springs specifically for your admission. Under a
single case agreement Wekiva Springs is then considered contracted
and you use your in-network benefit.
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