Is it possible to obtain insurance reimbursement for treatment at
La Europa Academy?

When considering the potential for insurance reimbursement the following questions and answers may help to guide the preparation process to position for positive outcomes.

  1. 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 carriers require pre-authorization and we provide two companies that can provide billing and authorization services if requested. Insurance will generally reimburse an out of network percentage of the full daily per diem amount up to a certain number of days (depending on how many they authorize. Pursuit of authorized days will be handled by our third party UR companies, either Denials Management, Inc (DMI) or SJ Health Insurance Advocates. Parent(s)/guardian are responsible for selecting the third party company and contacting them directly. They will provide billing of all authorized days to your insurance carrier. If a denial occurs at any stage of your claims, you can make contact with them and they will attempt to assist.  
  2. Does La Europa help me with my insurance company to get payment for my daughters stay? 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. DMI or SJ Health Insurance Advocates will initiate a claim and provide reasonable support to facilitate appropriate documentation for the benefit, including billing for applicable services.
  3. How does La Europa work with insurance? At La Europa we understand that accessing appropriate treatment for your daughter can pose a daunting financial challenge. The potential for accessing insurance payment to help defray some of the costs is a significant consideration. SJ Health Insurance Advocates and DMI have trained clinical teams to work with insurance reviewers to support appropriate care and benefit approval. 
  4. What can be done to help access my insurance benefits to pay for La Europa? If eligibility for residential benefits gets established, you should provide all needed information as promptly as possible and work closely with DMI or SJ Health Insurance Advocates staff throughout the process. 
  5. What is the likelihood that insurance will pay for a portion of my daughter’s care? Every insurance plan is different. It is important to familiarize yourself with your plan and the exclusionary criteria. We do have families who receive benefits for their daughter’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!