To help you understand the financial review process at Life Healing Center (LHC), we have listed out the typical steps that begin with your first call to us.
We strongly recommend for you to contact your company’s Human Resource Department Benefits Administrator and your Insurance Provider to see if your insurance plan does, in fact, have RTC (Residential Treatment Center) benefit(s).
Life Healing Center as a courtesy will also contact your insurance company and request information about your Mental Health and Substance Abuse benefits, specifically the benefit(s) for RTC, the primary level of care offered at LHC. This quote of benefits is NOT a guarantee of coverage, authorization or claim payment.
Note that treatment history is an essential component for most Insurance Providers to consider funding RTC level of care. Many companies require that a patient has tried other levels of care, such as inpatient, PHP (Partial Hospitalization Program) or IOP (Intensive Outpatient Program) prior to being eligible for RTC admission and treatment.
An Admissions Professional will review your insurance policy benefits as quoted by your insurance plan and ask about your clinical history via an over the phone consultation and triage with you to provide an educated opinion on the likelihood of insurance authorizing coverage for residential care at this time. This is never a guarantee.
You then take that information and determine for yourself the financial viability and secure funds to help cover the treatment cost(s) either as dictated by insurance or at our self-pay rate (non-insurance).
Once you have determined that Life Healing Center is the correct treatment program for YOU and the financial responsibilities will be viable. Call us directly to schedule your over-the-phone clinical assessment. An Admissions Professional will help guide you through this process as we collect the pertinent information for your consideration of acceptance to attend LHC. Once completed, the admissions assessment is reviewed by our Medical and Clinical Directors to ensure that your specific presentation is an exact fit for the clinical program provided here at Life Healing Center.
Once accepted via the review of your assessment, an admissions professional will call to notify you immediately of the determination. At this time you will be asked to secure your bed/date of admission by booking/providing your travel itinerary within 24-48hrs. Life Healing Center is not able to reserve a bed space for you without verifying your travel information.
After you arrive, your first round of insurance authorization is based upon a face-to-face psychiatric evaluation completed by our Medical Director within the first 24-48 hours of your arrival at Life Healing Center. In rare cases, the Insurance Provider could decide that RTC treatment is not medically necessary and may not authorize your stay.
Insurance Providers will typically authorize in 5-7 day increments, starting with your first day on campus.
An Insurance Provider may decide to discontinue authorization for RTC treatment after each of these intervals, based on their specific Medical Necessity Guidelines and screening criteria.
The length of time that insurance authorizes for coverage is not determined by Life Healing Center and may not always coincide with your treatment team’s recommendation for length of stay. If this happens, you may need to consider an alternate funding source to complete the length of treatment recommended by LHC. We typically recommend a minimum of 28 days. Additional financial options can be discussed with our financial counselor in the event of a denial.
Each individual insurance benefit plan is different. Some of the variations may be subtle and limitations of the plan can be easily overlooked. Be sure to verify your benefits with your company’s Human Resource Department Benefits Administrator and your Insurance Provider. The knowledge of your insurance coverage and the benefit(s), restrictions and/or exclusions therein are ultimately your responsibility. Life Healing Center provides the initial benefit verification process as a courtesy and cannot be held responsible for an inaccurate quote of your insurance benefit plan.
In the case of a difference in opinion between LHC and your insurance company about the medical necessity of residential care, you may receive a denial of coverage for ongoing care at the residential level. Typically when residential care is denied, your insurance company will provide a recommended level of care (PHP, IOP or outpatient).
Upon denial of coverage, LHC will notify you, the patient and guarantor (if applicable) in a timely manner when the Insurance Provider provides us with a notification of denial and we will inform you of your options, which can include appealing the decision or helping you find the appropriate treatment program for the level of care your Insurance Provider recommends.
The outcome of any appeal discussion between LHC and your insurance company may take one to three business days. Please note that any uncovered days during your stay will be part of your financial responsibility and obligation. All financial conditions will be agreed upon by both parties before your arrival and is a required part of each admission.