Does Insurance Cover Teen Mental Healthcare?

Insurance Verification

If you’re interested in exploring the possibility of treatment at Newport Academy for your teen’s mental health, behavioral health, or substance abuse issues, we can begin the insurance verification process immediately. Furthermore, we are happy to obtain your insurance policy information and seek verification on your behalf. You can also expedite this process by completing the insurance verification form. There is no obligation to either Newport Academy or to your insurance provider. We will generally get back to you with verification results and a comprehensive assessment of your insurance benefits coverage within 24 hours.

Clinical Review and Insurance Substantiation

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.

Coinsurance

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

Maximum Out of Pocket (MOOP)

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.

Allowed Amount

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.

Balance Billing

Balance billing is a practice in which an out-of-network treatment provider invoices the person who will be receiving treatment for the difference between what the insurance company paid and the actual cost of treatment. Newport Academy does not balance bill. What this effectively means is that we work to ensure maximum coverage by in- and out-of-network insurance providers, and once we collectively understand the insurance coverage options, our Admissions Specialists will work hand in hand with the family or individual to affirm the final cost of treatment. With some treatment centers, you’ll receive an invoice for a balance due after treatment, but Newport Academy does not support this practice. There will be no surprises.

Copay

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.

Primary Insurance Subscriber

This is the person whose name is on the insurance card. Many young adults in treatment qualify for coverage under their family’s insurance plan.

Premium

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.

Out-of-Pocket Expenses

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.

Policy Effective Date

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.

Managed Care

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.

Single-Case Agreement

A Single Case Agreement is when a provider, such as Newport Academy, negotiates a special contract so that out-of-network providers can work with your insurance company on an In-Network basis. Many of the teens and families who receive treatment from Newport Academy do so utilizing a Single Case Agreement, so we have extensive experience working with insurance companies to create Single Case Agreements for teens with mental health and co-occurring disorders. Our goal is to ensure that your insurance provider makes it possible for your teen to receive the most comprehensive and highest-quality treatment available.

Coverage Amount

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