Health insurance can be difficult to understand as insurance coverage and/or providers often change on a yearly basis. If your employer has recently taken on a new provider through open-enrollment, you surely have questions about what’s covered.
Hillside is happy to provide helpful information regarding mental health services in relation to insurance providers and coverage. Below is a listing of mental health insurance providers that we regularly work with and offer some type of mental health insurance coverage.
However, if you do not see your provider on this list, please contact us. We are constantly credentialing with new plans both commercial and Medicaid plans.
Also if we are not in-network with your plan, we can always work with you as an out-of-network provider. We have been successful in getting plans to agree to a Single Case Agreement to treat your child for this one stay as in-network providers. If the client meets clinical necessity criteria and DBT treatment is indicated, most plans will agree to these Single Cases as we are currently the only Child and Adolescent Residential Program in the nation that has been recognized by the DBT Linehan Board of Certification as a Certified Program. We also work with families with private or self-pay situations.
Accepted Insurance Providers Offering Mental Health Coverage:
Aetna
Alliant
Ambetter
Anthem
BCBS Blue Cross Blue Shield
Beacon Health Options (formerly “ValueOptions”)
Beacon Health Options – Georgia Collaborative ASO
Behavioral Health Solutions
Cigna
Cofinity
CompCare/CBH Care – Comprehensive Behavioral Healthcare, Inc.
ComPsych
Concentra Insurance/Principle Edge Network
Core Solutions/Gulf Stream
Consumer Choice First Health
Friday Health Plan
Healthscope/Walmart
HealthOne Alliance/Alliant Health
Humana/Humana One Health Plan of GA/Lifesynch – Humana Behavioral Health
Kaiser Permanente
Lifesynch
Maestro Magellan Healthcare
Meritan MHNet/Coventry Health Care
MultiPlan, Beech Street/Viant
Tricare Humana Military Insurance/Tricare
UMR
United Healthcare / United Behavioral Health (UBH) / Optum
United Health One
Accepted Medicaid Insurance Providers Offering Mental Health Coverage:
- Amerigroup Georgia – GA Medicaid
- Beacon Health Options – Georgia Collaborative ASO
- Caresource – GA Medicaid
- Peach State/Cenpatico – GA Medicaid
Hillside is not in-network with Medicaid plans outside of the state of Georgia. However, Hillside can work with some out-of-state Medicaid clients through a single-case-agreement as their plans allow due to the specialized treatment Hillside offers.
Paying for Mental Health Care
Most Hillside clients utilize medical insurance to cover some or all of their treatment costs. Private pay for treatment can also be arranged if insurance coverage is not available.
Each insurance provider and Medicaid coverage varies by state and/or plan. It is best to consult with your insurance provider to fully understand the coverage for mental and behavioral health treatment. Each provider will typically outline their coverage benefits on their website. If their mental health coverage is not outlined clearly or you do not fully understand the coverage, we recommend calling and speaking to a representative. On the back of your card, there should be a phone number for behavioral health or mental health benefits. Our admissions team members are happy to assist with coverage questions as well.
Prior to admission to any of our programs, our Admissions Staff will check your benefits and determine your insurance coverage and the out-of-pocket expenses. Based on the information our team is given, the admissions team will review with you your financial responsibilities including copays, co-insurance, and deductibles. Your portion of financial responsibility will be due prior to services or mental health treatment is provided.
Understanding Health Insurance & What to Expect from Insurance Providers
While mental and behavioral health treatment are usually listed as covered a benefit, your insurance provider will authorize treatment based on the insurance company’s guidelines for medical necessity of treatment. Each covered service has to be pre-approved by your insurance company prior to delivery of services.
If your insurer authorizes admission to one of our programs, they will specify the number of days they will initially approve for treatment. Generally, they authorize a short period of time initially, which prompts a clinical review shortly after admission so that the insurance company’s care manager can obtain information about our assessment of the client’s condition and initial response to treatment. For example, Partial Hospitalization Programs (PHP) or Day Programs, insurers may authorize an initial period of 1-3 days and Residential Treatment, insurers often grant 5-7 days, sometimes more, sometimes less. At the end of this initial period, Hillside’s Utilization Management Department will review the client’s progress with the insurer to get continued coverage for treatment. This is called “concurrent review.”
If the insurer determines that the client meets their ‘medical necessity’ criteria for continued treatment, they will authorize coverage for an additional period of time. The review process will continue like this throughout the course treatment at Hillside. We encourage parents to understand their insurer’s definition of medical necessity and any requirements the insurer has around family participation in treatment.
We will keep you updated on your child’s progress and will be working with you to coordinate a smooth transition home with needed support services. The care manager from the insurance company is often a great resource in identifying additional community-based services to ensure a successful transition. At some point in the utilization review process, the insurer may determine that the client is no longer, or close to no longer, meeting their established criteria for the program. If this is the case we will notify you. If we believe that there is additional information that could change that determination, we will ask your insurer to schedule a peer review. During a peer review, the client’s psychiatrist at Hillside will review the client’s progress with the insurer’s psychiatrist. Based on this review, additional days may be authorized.
If additional days are not authorized, your insurer will deny payment for continued days of treatment at Hillside. Our clinical staff will notify you of the insurance denial and discuss the treatment team’s recommendations and whether an appeal of the decision is appropriate. If you wish to continue your child’s treatment at Hillside in spite of the insurance denial or during the appeal process, you will be referred to Admissions to discuss private-pay options.
If there is an appeal, the process may go through several levels. It may take two to three days for each level of appeal and up to 30 days for an independent review done by a psychiatrist independent of your insurer. Your insurer may or may not reconsider their denial. If the denial is overturned, the insurer will make payment for all the days previously denied and will specify how many more days of treatment will be authorized for payment. It is possible the denial will be upheld and the cost of continued care is the responsibility of the parent/legal guardian.
My Insurance Provider Isn’t Listed or Doesn’t Provide Coverage – What Else Can I Do?
Please feel free to reach out to our Admissions staff prior to treatment. If Hillside is not currently contracted as an in-network provider for your insurance, we may be able to discuss a single-case-agreement or work to become an in-network provider as we are constantly credentialing with new insurance plans.
If your insurance provider does not offer coverage, you have the right to challenge your insurer’s decision with your care manager. You can and should also express your concerns with your employer’s benefits office or human resources.
The Admission Process
