At La Europa Academy we understands that accessing much needed, appropriate treatment for your child can pose a daunting financial challenge. The potential of accessing insurance coverage to help defray some of the cost is a significant consideration. For this reason La Europa works with a third party insurance advocacy and billing company to provide insurance services such as verification of benefits, pre-authorization/certification, utilization review, submitting claims directly or handling appeals. This third party insurance billing company prefers to start working with a family prior to enrollment. This is much more effective than playing catch-up after an insurance company has issued a denial.
When factoring the potential for insurance coverage it is important to understand that parents are always responsible for payment of the monthly tuition, fees for services and all costs associated with care at the time of billing regardless of potential insurance coverage. When an insurance payment is received it is applied to the student’s account and the compensatory reduction will be reflected in the next billing cycle. Potential insurance coverage does not modify the payment agreement.
The following questions and answers may help to better understand how obtaining insurance benefits might work:
- Is it possible to obtain insurance reimbursement for treatment at La Europa Academy? Coverage of residential treatment is now mandated by most state and federal laws. Most insurance companies require pre-authorization. They will pre-authorize if they consider treatment medically necessary. If an insurance company authorizes coverage, they typically do so in 3-7 day increments. After this initial period, the insurance company will request additional clinical information to authorize additional days. Once an insurance company determines that a student no longer meets their definition of medical necessity, it is likely they will deny authorization for the full daily rate of residential treatment. When an insurance will no longer authorize for the daily rate, some insurance companies will continue to pay for individual, family and group therapy sessions. If a denial occurs at any stage of your claims, the insurance billing company will attempt to assist you with an appeal. Because La Europa is not a provider on any insurance, most insurance companies might reimburse at an out of network percentage of our posted daily rate.
- Does La Europa help me with my insurance company to get payment for my child's stay? La Europa does not work directly with any insurance carriers. Instead we recommend families work with our third party insurance billing company. This company will provide all insurance services including authorizations, utilization reviews and billing for all authorized days to your insurance carrier. If a denial occurs at any stage, the insurance advocacy company can also assist in an appeal if you choose to do so. La Europa will make our clinical records available to your insurance advocate to assist them in the process of continuing authorization, utilization review and submitting claims.
- How can I help access my insurance benefits to pay for La Europa? Prior to admission, you will provide your insurance information to La Europa. By default this information is immediately directed to our third party insurance billing company. They will contact your insurance to determine what kind of coverage you might have for residential treatment. If eligibility for residential benefits is established, you should provide all needed information as promptly as possible and work closely with our billing company throughout the process. Our insurance billing company will initiate a claim and provide reasonable support to facilitate appropriate documentation for the benefit, including billing for applicable services.
- What is the likelihood that insurance will pay for a portion of my child's care? Every insurance plan is different. It is important to familiarize yourself with your plan and the exclusionary criteria. Once an insurance carrier will no longer authorization for the daily rate, our insurance billing company can continue to submit claims for individual, family and group therapy sessions. We do have families who receive benefits for their child’s care but it takes time and diligence. Our Clinical team strives to provide the necessary documentation to potentially defeat insurance denial. Getting insurance funds is a team effort!