Insurance Companies

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 healthcare experience.

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

1. 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.
    
2. 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.
3. 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:
   1. Is there an available benefit for this type of service and
   2. 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 differentiate between and mental health and substance abuse conditions. Be sure to check under each area.
4. 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.
5. My insurance card lists one type of insurance but when I call, I reach 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.
    
6. 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.
7. 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.