FAQs About Payment
Frequently Asked Questions Related to Financial Services and Insurance
1. I don’t understand. I have good benefits…why isn’t this covered?
Insurance companies ask two questions when a call is made to access services: One: Is there an available benefit for this type of service and Two: Is it medically necessary?
If the answer to either of these questions is “no” then the insurance company will usually deny payment. If denied, you may contact your insurance company and request an appeal to their decision. The number to call is on your insurance card or is located on your member rights and responsibilities brochure supplied to you by your employer or insurance company.
For more information on what your insurance company determines is medically necessary, please go to the website on your insurance card. Please keep in mind, they will differentiate between and mental health and substance abuse conditions. Be sure to check under each area.
2. What constitutes a medical necessity? Who determines if my treatment is medically necessary?
Your insurance company looks at this term globally whereas Starting Point Behavioral Healthcare looks at it from an individual stand-point. Your insurance company has its own clinical criteria for inpatient, residential and outpatient services. This is a guide used by your insurance to define medical necessity based on diagnosis.
At Starting Point Behavioral Healthcare each patient has a treatment team which takes a holistic approach to your care.It is possible that you do not meet the global insurance medical necessity criteria; however, due to your individual situation your treatment team will recommend specific services.
3. My insurance card says one insurance but when I call, it’s a different number for mental health.
Health Insurance providers often use another contracted company for mental health and substance abuse services.These companies, known as carve-outs, are behavioral health organizations (BHO) contracted with the health insurance company to manage your mental health services.
Also, we must determine if Starting Point Behavioral Healthcare is covered by these carve-out behavioral health organizations. Just because we accept the main insurance, does not always mean that we are covered by the carve-out plan.
4. What does Starting Point Behavioral Healthcare do to help me with my insurance?
Starting Point Behavioral Healthcare has contracted with several major insurance companies in the state of Florida and some national and international insurance plans. By contracting with your insurance company the patient will receive the benefit of using the in-network benefit of their policy. Starting Point Behavioral Healthcare is contracted with major insurance companies to include Medicare, Florida Medicaid, Florida Blue, CIGNA, United Healthcare, Tricare, Wellcare, etc. If your health plan is not contracted, our admissions staff will work diligently to obtain authorization for Out-of-Network benefits. Your Out-of-Network benefits may require higher out of pocket costs.
5. What is an authorization for Out-of-Network benefits?
An authorization is a contract between your insurance company and Starting Point Behavioral Healthcare specifically for your admission. Under an authorization, Starting Point Behavioral Healthcare is then considered contracted and you use your out-of-network benefit for services.