If you have health insurance, Mountain Vista Farm would like to provide you with some information that may be helpful in understanding your coverage.
Verifying your benefits and getting authorization
Whether you have a Preferred Provider Organization (PPO) plan, or a Health Maintenance Organization (HMO) plan, before your admission, we must first verify your insurance benefits and obtain authorization for your treatment. This is done through our managed care department.
The benefits you have been quoted either by Mountain Vista Farm and/or your health care insurance company are the maximum benefits allowable by your plan. This does not necessarily mean that your insurance company will authorize payment for the maximum.
In addition to verifying that you have coverage, our managed care department must also obtain an initial authorization for treatment. (The insurance company’s authorization indicates what they determine to be medically appropriate according to your plan. Our Managed Care Department will work with your insurance company to maximize your stay at Mountain Vista Farm. There are two types of authorizations required by most insurance plans:
- A “pre-authorization review” at the beginning of your stay; this will result in either an admission authorization, or a denial notification (they determine that they will not cover the costs of treatment.)
- A “concurrent review” process by the insurance company’s medical review team. This involves our reviewing your case with the insurance company to justify your continued stay. This process may happen several times during your course of treatment.
If your admission or continued authorization has been denied, the insurance company will require us to follow an appeals process. This may involve having our medical director review your case with the insurance company’s physician. This may take several days before a final determination is established. It is important for you to realize that you could be responsible for the cost of treatment during this non-certified period.
Your share of costs
Many insurance plans involve paying an annual deductible and/or co-payments before the insurance company begins paying for your treatment. These co-payments/deductibles are due at the time of admission, unless arrangements have been made with the administrative office beforehand.
Some health insurance plans have a maximum allowable rate. This means that your insurance company will only cover a certain amount of your stay, and you are responsible for any monies above the insurance company’s maximum allowable rate. If this is the case with your policy, you will need to make arrangements to pay your share at the time of admission.
What if I am “Stepped Down” to a lower level of care?
If your insurance company determines that you could, at least in theory, benefit from a lower level of care than Residential Treatment they may lower the level of reimbursement for treatment. When this occurs, we are often able to allow clients to continue in the residential program uninterrupted by paying a “Room and Board” fee in addition to the insurance coverage. However, some insurances do not allow this option. If such a “step-down” occurs with your coverage, MVF staff will assist you in exploring your options.
For clients who may need to borrow funds to assist with treatment costs, we are able to refer clients or their families to an insurance brokerage specializing in loans for healthcare. (The brokerage is a completely separate organization and has no formal connection with Mountain Vista Farm.) For more information about this option, call Mountain Vista Farm at 707-996-6716.
If you have more than one insurance policy
You must inform the managed care department at the time of your admission if you have more than one policy so that a coordination of insurance benefits can be determined. This means that we will need to make sure that your individual plan or employer’s policy is used before attempting to use your secondary policy. Please note: the secondary insurance policy will refuse to pay for your treatment until your primary insurance plan’s benefits are exhausted; only then will the secondary policy pick up what is not covered by your primary health insurance plan.
If there are changes in your policy
It is your responsibility to inform Mountain Vista Farm’s managed care department of any changes to your health insurance policy i.e., plan discontinuations, COBRA plan alternatives, or changing from one health insurance plan to another, during your treatment.
If you have any other questions
Please call us at: 707-996-6716 if you have any questions or concerns about your insurance.