INSURANCE What you need to know 

 


Legacy is the only Residential Treatment Center and Outdoor Behavioral Healthcare accredited program in the country that bills insurance directly! 


Families can and should get cost-effective and valuable addiction treatment when it’s needed. Legacy is prepared to help families achieve this goal.  

  1. We verify and preauthorize benefits on the front end of treatment.

  2. We contact insurance companies directly to clarify the policy and coverage for the family. 

  3. We work with insurance companies even when out-of-network. 

This means families may get some relief from paying the full price of treatment


Pre Authorizing treatment


Legacy Outdoor Adventures has obtained the necessary licensure and acquired the expertise to proactively pursue insurance authorization on behalf of clients served. 


Elevated billing 10% processing fee


Legacy works with an outside agency to verify benefits, authorize the provision of treatment, continue the authorization process through Utilization Reviews (UR), bill for services, appeal denials, and provide other related services. For these services, this agency charges a fee of 10% of the total amount paid by the insurance company, which will be deducted from the amount of the insurance reimbursement credited to my account. 


If you will be utilizing insurance benefits, our authorization and billing agency will bill the insurance company. We will reimburse you for claims paid after a processing fee of 10% of claims paid is collected by the billing agency. Payment of the first month’s deposit and the enrollment fee is still required before enrollment into the program. 


Verification of benefits does not guarantee treatment


Legacy will verify Client’s benefits with the insurance company prior to enrollment; however, verification of benefits does not guarantee treatment will be covered by the insurance. Upon admission, Legacy will complete a thorough assessment of Client and work with the outside agency to prove the Client’s treatment is medically necessary. Upon deeming treatment is medically necessary, the insurance company will issue an authorization for treatment. Likewise, receiving authorization from the insurance company to provide treatment does not guarantee payment of benefits 


Information Needed in Order to Verify Insurance (needed for online authos as well)


  • Name of Insurance Company

  • Primary First and Last Name

  • Primary SSN and DOB or Member ID # or Health Record #

  • Patient’s First and Last Name

  • Information Needed in Order to Verify Insurance continued

  • Patient’s DOB

  • 800 # for Provider’s use

Information Needed in Order to Verify Insurance continued

  • Patient’s DOB

  • 800 # for Provider’s use

Will attempt to gain authorization for a lower levels of care


Insurance companies rarely authorize more than a few weeks of treatment at a time. Once an authorization expires, insurance companies require periodic URs, which are completed by a member of the Legacy clinical team working in conjunction with the outside agency to prove medical necessity for continued treatment. URs are labor intensive in that they require providing a thorough and detailed update on Client progress. Therapists complete multiple URs on each Client, often required every few days for continued authorizations. Legacy will initially attempt to gain authorization for the highest level of care available under the policy benefits, usually Residential Treatment Center (RTC). Even when authorized initially, the level of care is often denied partway through treatment. Legacy then works with the outside agency to appeal the denial and seek the maximum extension of time for the higher level of care. If the appeal fails, Legacy will attempt to gain authorization for a lower level of care. Levels of care in descending order are RTC, Partial Hospitalization (PHP), Intensive Outpatient (IOP), and General Outpatient (GOP). Insurance reimbursement rates decrease with each level of care.


Insurance does not cover the entire cost of the program


Insurance does not cover the entire cost of the program. Additionally, the amount covered varies greatly among insurance companies. The portion of the cost not covered by insurance includes the enrollment fee, co-pay amounts, deductible amounts, treatment costs that exceed the insurance company’s designated percentage of their allowable amount, days of the week treatment is not authorized, and any days a client stays at Legacy after the treatment authorization has expired.


Families are responsibility for the balance


Working in tandem with the outside agency, Legacy will attempt to collect the maximum amount of Client’s entitled benefits from the insurance company. Parents are responsibility for the balance of any amount of the total cost of the Legacy program not paid by insurance. Final payments are not received from the insurance company until after the Client graduates from Legacy, often 90 days or more. The financial obligation remains in effect until the final reconciliation with insurance payments is calculated and I have paid the balance due.


Families send the insurance payments to Legacy


If the insurance company sends payments for Client’s stay at Legacy directly, families agree to send the entire amount of all insurance payments to Legacy. Legacy will deduct 10% of all insurance payments to send to the billing agency and credit the balance of the insurance payment to my account. Legacy will reimburse to me the credit remaining in my account after the final payment is received from the insurance company


No way of knowing what that allowable amount is


Insurance companies will only pay a percentage of their allowable amount for days of treatment authorized, and Legacy has no way of knowing what that allowable amount is until the insurance company pays. Also, Legacy has no way of predicting how many days of treatment will be authorized. The daily rate Legacy bills insurance may be more than the monthly rate I have agreed to pay. I cannot receive more in reimbursements from insurance than I paid for any given day of treatment.


Our admissions experts are committed to helping families navigate the health insurance process to ensure families receive the their maximum benefits. Call us at (866) 436-4458 today for a free insurance benefits check.

ACCREDITATIONS, AFFILIATIONS AND PARTNERS

Legacy programs are highly respected by the Outdoor Behavioral Healthcare Council (OBH) as well as other leaders in mental and behavioral healthcare. 

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LEGACY OUTDOOR
ADVENTURES

ADDRESS: P.O. BOX 400 LOA, UT 84747

TOLL FREE: (866) 436-4458  |  OFFICE: (435) 836-2272  |  FAX: (435) 836-2274 admissions@legacyoutdooradventures.com

© 2019,Legacy Outdoor Adventures