If you’re interested in exploring the possibility of treatment at Newport Institute for you or your loved one’s mental health, behavioral health, or substance abuse issues, we can begin the insurance verification process immediately. Furthermore, we are happy to obtain your insurance policy information and seek verification on your behalf. You can also expedite this process by completing the insurance verification form. There is no obligation to either Newport Institute or to your insurance provider. We will generally get back to you with verification results and a comprehensive assessment of your insurance benefits coverage within 24 hours.
The majority of insurance providers require pre-certification, or authorization, prior to entering the program and continuously throughout treatment. We will guide you through this process as well. Consequently, if your policy has this stipulation, we will provide you with support and direction on how best to proceed. If you don’t see your insurance provider in the list above, that does not mean that we cannot work with them—it might simply mean that we haven’t worked with them previously.
Clinical Review and Insurance Substantiation
Clinical reviews take place on an ongoing basis, depending on the individual’s specific case and insurance company. We will also file appeals for any denials and bill the insurance company directly. Our team of insurance review experts assist families with this process on a daily basis. While other facilities may charge for this service, we feel it is our responsibility to help you and your family receive the highest-quality treatment.
Your deductible is an annual amount that you must pay before insurance will begin to cover your expenses. Typically, once the deductible has been satisfied for the year, your mental health insurance policy will start to cover a percentage of the total treatment costs, called the coverage amount.
Coinsurance is the percentage of treatment costs, after the deductible, that your mental health insurance policy will not cover. You are responsible for this amount.
Maximum Out of Pocket (MOOP)
The MOOP is a limit on your policy set by your insurance company. Once the total amount of coinsurance paid equals the MOOP, the insurance policy typically covers 100 percent of the “allowed amount.” Sometimes, the deductible applies toward the MOOP, which can help you meet that limit faster.
The allowed amount is the daily rate that the insurance company feels is appropriate for the services rendered. The allowed amount may be exactly what you are invoiced for services, or it may be less. It is important to note that, for out-of-network services, the rehab insurance coverage amount percentage applies to the allowed amount, and is not necessarily reflective of invoiced amounts or cost of services rendered.
Balance billing is a practice in which an out-of-network treatment provider invoices the person who will be receiving treatment for the difference between what the insurance company paid and the actual cost of treatment. Newport Institute does not balance bill. What this effectively means is that we work to ensure maximum coverage by in- and out-of-network insurance providers, and once we collectively understand the mental health insurance coverage options, our Admissions Specialists will work hand in hand with the family or individual to affirm the final cost of treatment. With some treatment centers, you’ll receive an invoice for a balance due after treatment, but Newport Institute does not support this practice. There will be no surprises.
A copay is a regular fixed cost that you pay for certain services. For example, many people pay a small copay each time they visit a doctor. This contributes to your overall plan and is part of your cost agreement with the insurance company. Some insurance plans do not require copays.
Primary Insurance Subscriber
This is the person whose name is on the insurance card. Many young adults in treatment qualify for coverage under their family’s insurance plan. Under the Affordable Care Act, young adults 26 years of age and under are entitled to their parents’ health insurance policies, which, through the exchanges, are required to provide mental health benefits.
A premium is the amount that people pay at regular intervals to their insurance companies for their coverage. This is the individual’s contribution to their policy, and in some cases, employers may also contribute to the premium. Premiums are determined by what kind of coverage a person has, such as an HMO or PPO plan.
Your out-of-pocket cost is the amount of money you must pay each time you visit a doctor or receive inpatient, outpatient, or other therapeutic treatments. These costs are usually due at the time treatment begins, but you may also be able to pay them a little at a time with payment plans. Out-of-pocket expenses include deductibles, copays, and co-insurance.
Policy Effective Date
This is the date when your mental health insurance company begins to help pay for your healthcare costs. You must enroll in a health insurance plan either during the open enrollment period, usually offered for a set amount of time once a year, or during a “special enrollment period.” Special enrollment periods begin after a qualifying event, such as marriage, the start of a new job, the birth of a baby, or the loss of healthcare coverage, and usually last for about 90 days. Your policy effective date is determined after you’ve enrolled, and usually falls a few weeks or months after your initial enrollment date.
This blanket term is used to describe the primary system through which healthcare services are provided in the United States. An insurance company directs—i.e., manages—the way you receive treatment, from regular checkups to accidents to major illnesses. Managed Care Organizations (MCOs) include the doctors, hospitals, laboratories, and clinics that make up your network.
Insurance Plan Types
Newport Institute works with an array of mental health insurance plans. Plan types break down into two categories: those with out-of-network benefits and those without out-of-network benefits. Plan types that typically offer out-of-network benefits are Preferred Provider Organization (PPO) and Point-of-Service (POS) plans. Plan types that typically don’t offer out-of-network benefits are Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) plans. The bottom line: We pride ourselves on being able to work with the majority of major insurance companies, to help young adults receive the best treatment possible, as soon as possible.
A Single Case Agreement is when a provider, such as Newport Institute, works out a special contract so that out-of-network providers can work with your insurance company on an in-network basis. Many clients who receive treatment from Newport Institute do so within a Single Case Agreement, so we have extensive experience working with insurance companies to create Single Case Agreements for young adults with emotional, behavioral, or substance abuse disorders. Our goal is to ensure that your mental health insurance provider makes it possible for young adults to receive the most comprehensive and highest-quality treatment available.
The coverage amount is the percentage of treatment costs, after the deductible, that your mental health insurance policy will cover.