EGBS and Insurance

[lisak2]

I have really good insurance. I work for Sysco Food Services and thru them have United Behavioral Health. They say they will pay unlimited visits to out patient, and unlimited days of inpatient as needed. This sounds great. I am wondering though, if you know, if the insurance companies might pay for part of an EGBS? There is one that is actually more like an EGBS, Kolob Canyon, I am looking into, but it classifies itself as an Residential Treatment Center (RTC). Maybe they would pay for that? Thanks.

 

[bigblueagain]

if the facility bills under a location code for therapeutic residential treatment center, I don't see why UBH won't pay it if they deem it is medically necessary. I would call the facility first and see if that is how they bill. Then ask if the particioate with whatever network UBH has set up for your area. I would also call UBH and get the exact wording of your benefits, and then ask how you would go about getting your child set up for a residential admission. There should be an inpatient case manager who would be assigned. They should have the criteria also for admission approval. Will probably need to have a letter of medical necessity from your doctor for starters. Also check what happens if this facility is not in network .........do you have out of network benefits. Once you find out a little more then get back with me and we'll go from there.BLUE