Out of Network Insurance for Silver Hill Residential Programs
Our Residential programs are often covered by insurance on an out-of-network basis. Many of our patients utilize out-of-network insurance reimbursement to help finance treatment.
We work assertively to help patients and families obtain out-of-network reimbursement from their insurance plan. As a result, many patients with insurance policies offering out-of-network benefits receive partial coverage.
All insurance companies have different plans and policies; therefore, reimbursement amounts vary.
You can help Silver Hill’s Patient Accounts team by providing us with information about who your health insurer is and what insurance policy you have.
How will I know I am covered for treatment?
Before coming to Silver Hill for your admission, we will ask you to provide us with information about your health insurance company and plan. Our Patient Accounts team will contact your insurer to understand if you have an out-of-network benefit for residential mental health on your plan.
On the day of admission, our Patient Accounts team will meet with you and your family to review information related to the payment for treatment as well as information provided by your insurer regarding your coverage.
Shortly after admission, Silver Hill will contact your insurer to review your case and treatment and verify if you have out of network mental health benefits. Silver Hill uses the Level of Care Utilization System (LOCUS), a nationally recognized standard, to determine medical necessity. Please note that each insurer uses their own set of medical necessity criteria. We relay all pertinent information to your designated contact person (it may be you, or an authorized parent/family member.)
What do I and my family need to do in this process?
You need to provide us with information about who your health insurer is and what insurance policy you have. The more familiar you are with your policy and benefits, the better. We will communicate openly and honestly about the process throughout your care.
What does Silver Hill do to ensure reimbursement?
Silver Hill cannot ensure that an insurance company will provide reimbursement for the residential care provided by Silver Hill, but we can guarantee that we will work assertively on your behalf throughout the process.
- We complete an initial screening to understand if you have an insurance benefit for treatment at Silver Hill.
- Following admission, we contact your insurance to work to obtain authorization for residential treatment. If approved, we conduct reviews throughout your stay for as long as the insurance company deems the treatment to be medically necessary.
- We also notify you and/or your family when coverage is denied. Denials can happen for a variety of reasons including improvement in the patient’s mental health status. We are always available by phone to consult and provide information related to insurance matters.
How long does it take for insurance companies to let patients know how much coverage they will get?
This can vary greatly depending on your individual insurance policy and the insurer’s responsiveness. Generally, we will know if you are covered within days of admission. How much coverage you may receive depends on a number of factors.
Silver Hill has a team dedicated to working directly with insurance companies to help navigate the process.
How many of Silver Hill’s patients receive reimbursement and how much do they receive?
Silver Hill’s Utilization Review team provides information to your insurance company to help support your case for reimbursement. Given that plan policies vary, we cannot guarantee what, if any, amount will be reimbursed. You can help us obtain preauthorization by giving us information about your plan and the details of your specific policy.
Although Silver Hill’s residential programs are not “in-network” with any health insurance plans, the majority of patients with insurance policies offering out-of-network benefits receive coverage to support some of the cost of treatment. Payment is typically based on insurance companies’ “usual and customary” daily rate.
Insurance companies are generally aware of mental health parity laws, which helps the case for getting coverage. It does vary by company and state, but we are seeing most patients receive some coverage for residential treatment at Silver Hill. The length and amount of coverage still varies widely but we’re seeing more patients being covered for more days of treatment, as well.
What happens if my insurance does not authorize coverage for my complete stay or at all?
All patients pay for the full length of their stay prior to being admitted and we want you to know if part of your stay will be covered by your insurance.
If your insurance plan does not include benefits for out-of-network healthcare providers, like Silver Hill, we will notify you before your admission.
For those patients who do have out-of-network benefits, we continue to work with your insurance company throughout your stay to ensure that they cover as many days of your stay at Silver Hill, as possible. If we are informed by your insurance company that they will not pay for additional days, we will notify the person who is financially responsible for your stay.
If your insurance company has denied your preauthorization, it is your responsibility to manage the insurance appeals process. You will need to provide your insurance company a written request for an appeal and send your medical records to the insurance company.
There are many advocacy groups who assist patients with insurance reimbursement. Silver Hill Hospital does not have contractual relationships with these advocates, but we are always eager to work alongside them to assist with reimbursement.
One such non-profit is Cover My Mental Health, which has many resources available.
The National Alliance for Mental Illness, Mental Health America, and state Insurance Commissions are also resources available to individuals who are disputing their insurance coverage.