Affordable Care That's Covered By Insurance

The majority of insurance providers require pre-certification, or authorization, prior to entering the program and continuously throughout treatment. We will guide you through this process as well. Consequently, if your policy has this stipulation, we will provide you with support and direction on how best to proceed. If you don’t see your insurance provider in the list above, please reach out to our team, who can work with you to determine your insurance coverage.

At Newport Academy, we take great pride in the fact that we have a full-time, in-house team dedicated to supporting our families through the process of obtaining insurance coverage for mental healthcare. In order to secure sufficient insurance coverage, we will most likely need to conduct a series of clinical reviews and any requested doctor-to-doctor calls with the insurance company. These reviews take place every two to 14 days, depending on the individual’s specific case and insurance company. We will also file appeals for any denials and bill the insurance company directly. Our team of insurance review experts assists families with this process on an ongoing basis. While other facilities charge for this service, we feel it is our responsibility to help you and your family receive the highest-quality treatment.

The allowed amount is the daily rate that the insurance company feels is appropriate for the services rendered. The allowed amount may be exactly what you are invoiced for services, or it may be less. It is important to note that, for out-of-network services, the insurance coverage amount percentage applies to the allowed amount, and is not necessarily reflective of invoiced amounts or cost of services rendered.

Your deductible is an annual amount that you must pay before insurance will begin to cover your expenses. Typically, once the deductible has been satisfied for the year, your insurance policy will start to cover a percentage of the total treatment costs, called the coverage amount.

Coinsurance is the percentage of treatment costs, after the deductible, that your insurance policy will not cover. You are responsible for this amount.

The MOOP is a limit on your policy set by your insurance company. Once the total amount of coinsurance paid equals the MOOP, the insurance policy typically covers 100 percent of the “allowed amount.” Sometimes, the deductible applies toward the MOOP, which can help you meet that limit faster.

A copay is a regular fixed cost that you pay for certain services. For example, many people pay a small copay each time they visit a doctor. This contributes to your overall plan and is part of your cost agreement with the insurance company. Some insurance plans do not require copays.

This is the person whose name is on the insurance card.

A premium is the amount that people pay at regular intervals to their insurance companies for their coverage. This is the individual’s contribution to their policy, and in some cases, employers may also contribute to the premium. Premiums are determined by what kind of coverage a person has, such as an HMO or PPO plan.

Your out-of-pocket cost is the amount of money you must pay each time you visit a doctor or receive inpatient, outpatient, or other therapeutic treatments. These costs are usually due at the time treatment begins, but you may also be able to pay them a little at a time with payment plans. Out-of-pocket expenses include deductibles, copays, and co-insurance.

Newport Academy has successfully worked with behavioral healthcare insurance plans both In-Network and out of network. Plan types that typically offer out-of-network benefits are Preferred Provider Organization (PPO) and Point-of-Service (POS) plans. Plan types that typically don’t offer out-of-network benefits are Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) plans. The bottom line: We pride ourselves on being able to work with them all, to help teens and their families receive the best treatment possible, as quickly as possible.

This is the date your insurance company begins to help pay for your healthcare costs. You must enroll in a health insurance plan either during the open enrollment period, usually offered for a set amount of time once a year, or during a “special enrollment period.” Special enrollment periods begin after a qualifying event, such as marriage, the start of a new job, the birth of a baby, or the loss of healthcare coverage, and usually last for about 90 days. Your policy effective date is determined after you’ve enrolled, and usually falls a few weeks or months after your initial enrollment date.

This blanket term is used to describe the primary system through which healthcare services are provided in the United States. An insurance company directs—i.e., manages—the way you receive treatment, from regular checkups to accidents to major illnesses. Managed Care Organizations (MCOs) include the doctors, hospitals, laboratories, and clinics that make up your network.

The coverage amount is the percentage of treatment costs, after the deductible, that your policy will cover using behavioral healthcare insurance.