Residential Treatment Center FAQ

Residential Treatment CenterWith an increasing societal focus on mental health issues and problems with substance abuse, treatment options are now often covered by health insurance policies. One of these options is staying at an overnight facility that offers comprehensive treatment options for a wide range of mental and substance abuse problems.

  1. What is a residential treatment center?
  2. How do residential treatment centers differ from other forms of care?
  3. What is the difference between residential treatment and inpatient care?
  4. How do I know if my insurance policy will cover residential treatment center stays?
  5. Why was my residential treatment center claim denied by my insurance carrier?
  6. What can I do if my insurance denies coverage for a residential treatment center?
  7. How does the appeal process work for denied residential treatment center claims?
  8. Do I need to hire a residential treatment center attorney?

What is a residential treatment center?

Residential treatment centers offer teens and adults an intensive therapy solution to substance abuse and addiction. People of all ages receive 24-hour treatment in a facility away from their homes.Patients typically enter residential treatment centers after previous unsuccessful attempts at recovery. Residential treatment centers help address:

  • Addiction
  • Cognitive development issues
  • Compulsive behavior disorders
  • Eating disorders
  • Personality disorders
  • Substance abuse
  • Trauma

How do residential treatment centers differ from other forms of care?

Treatment plans vary depending on each individual case, and there are a variety of options available for both outpatient and complete inpatient care:

  • Intensive outpatient: Patients stay at home, but attend multiple therapy sessions each week
  • Partial hospitalization: Patients sleep in their own homes, but spent most of their time in treatment programs
  • Residential treatment centers: Treatment and observation is 24/7 with stays lasting weeks, months, or years

What is the difference between residential treatment and inpatient care?

The terms residential treatment and inpatient care are often used interchangeably, but there are substantial differences with each approach. Residential treatment often involves longer stays and offers a more casual environment dedicated to comfortable accommodations. In-patient treatment generally involves a shorter stay in a more sterile, clinical hospital setting.

How do I know if my insurance policy will cover residential treatment center stays?

Pre-approval may be needed prior to your insurance policy covering a stay at a residential treatment center. Refer to the details in your policy or contact your insurance carrier representative to ensure coverage for your stay.The Mental Health Parity and Addiction Equality Act of 2013 makes it illegal to deny coverage for inpatient treatment for a variety of substance abuse and mental health issues. If you feel you are being unfairly denied treatment, contact a residential treatment center attorney at DL Law Group.

Why was my residential treatment center claim denied by my insurance carrier?

Insurance companies will do whatever they can to try to get out of paying for any service, including a residential treatment center claim that should be covered in your policy and all the paperwork has been properly filed.Common reasons for denied residential treatment center claims include:

  • Lack of required pre-authorization
  • Missed filing deadlines
  • Service is not covered by policyholders plan
  • Service to be determined not medically necessary
  • Patient used out-of-network provider
  • Service received was experimental
  • Treatment was at a higher level of care than the circumstances dictated
  • Payment request was more than the policyholder’s plan limits for the treatment

What can I do if my insurance denies coverage for a residential treatment center?

The course of action to have a coverage denial overturned depends on why the residential treatment center claim was denied. Inaccurate or incomplete claim form information can be corrected by simply submitting the proper information.If you feel you need residential treatment, time is of the essence. If you are having issues getting a stay approved, contact a residential treatment center attorney at DL Law Group for assistance and representation.

How does the appeal process work for denied residential treatment center claims?

The process of appealing a residential treatment center claim is in the information provided to you when you first sign up for your insurance policy. Your insurance company must provide you a replacement copy if needed.Nearly all claim decisions are subject to appeal, and some insurance companies allow for multiple appeals. For example, in California, a patient with an internal appeal denial can file an external appeal.

If you feel your residential treatment center insurance claim was unfairly denied, a residential treatment center attorney at DL Law Group can help. A team of experienced of residential treatment center insurance specialists will immediately go to work on your behalf to expedite the process to get you the help you need as quickly as possible.

Do I need to hire a residential treatment center attorney?

When it comes to issues of mental health and substance abuse issues, there is no time to waste trying to argue with your California insurance company about coverage for treatment options. An experienced residential treatment center attorney at DL Law Group can work through your case file to help ensure you get the assistance you need, in the shortest amount of time.

The first step in getting your claim approved for mental health and substance abuse treatment is to contact an experienced San Francisco health insurance claims attorney at DL Law Group. Call toll free at (415) 678-5050 today to schedule a free consultation about your case, or fill out the contact information form on our website, and someone will be in touch.