Practical Considerations – Insurance Billing

Liz — Tue, 07 Apr 2009 00:50:00 +0000

As all of you know, these programs can be quite expensive. As such, going through this process I was delighted to learn that at least a portion of program expenses are reimbursable by some insurance companies.

With this said, depending on your circumstances and your insurance company’s requirements, if your child is not already enrolled in a program, your insurance company may need to be contacted immediately (e.g. for preauthorization). In all cases, as soon as you’re able, I recommend that you

- contact your insurance company and assess your son/daughter’s coverage,

- determine what information the insurance company will need to process claims,

- determine whether the program will bill the insurance company for you – as I’ve mentioned before I suggest asking the program this question prior to enrollment (during your site visit),

- if the program bills for you, you will need to decide whether the reimbursed funds will be sent to you or the program. In our case, we chose sending the reimbursement to the program. The program then deducted any reimbursement from the next month’s tuition. In short, reimbursements were always lagging behind – in fact, there were refunds still due to us by the time our daughter completed her program.

- if you are doing the billing, request that the program split costs into different categories (e.g. individual therapy, group therapy, etc.) as this will make it easier for you to bill the insurance company.

- regardless of who receives the reimbursement, it is important to keep track of refunds as you will need this information for your taxes.

As a note, when we first started the process, our insurance company challenged all expenses. In our case, several weeks before our daughter’s crisis we had changed our insurance company so when expenses started coming in, the insurance challenged these claiming they were a pre-existing condition. We had to provide letters from our daughter’s therapist and doctor for the insurance company to pay any expenses. My point in sharing this is that you may find yourself arguing with the insurance company but be persistent.

By the way, through a recent change in legislation, mental health policies/insurance will be changing favorably – stay tuned.

Angels in the Rough » Insurance

Practical Considerations – Insurance Billing