Insurance Coverage

Insurance Verification (benefits investigation)

If you’re interested in exploring the possibility of treatment at BestMind Behavioral Health for your or your loved one’s behavioral health or depression treatment, we can begin the insurance verification process. There is no obligation to either BestMind or your insurance provider. We will generally get back to you with verification results and a comprehensive assessment of your insurance benefits coverage within 24 hours.

Coinsurance

After the deductible, Coinsurance is the percentage of treatment costs your mental health insurance policy will not cover. You are responsible for this amount.

Copay

A copay is a regular fixed cost that you pay for certain services. For example, many people pay a small copay each time they visit a doctor. This contributes to your overall plan and is part of your cost agreement with the insurance company. Some insurance plans do not require copays.

Premium

A premium is the amount people pay their insurance companies regularly for their coverage. This is the individual’s contribution to their policy; in some cases, employers may also contribute to the premium. Premiums are determined by a person’s coverage, such as an HMO or PPO plan.

Insurance Plan Types

BestMind Behavioral Health works with an array of insurance plans providing coverage for mental health treatment. Plan types break down into three categories: those with In-Network benefits, those with out-of-network benefits, and those that typically don’t offer out-of-network benefits. Plan types that typically provide out-of-network benefits are Preferred Provider Organization (PPO), and Point-of-Service (POS) plans. Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO) plans typically don’t offer out-of-network benefits. The bottom line: We pride ourselves on working with most major insurance payers to help our community receive the best treatment possible as soon as possible.

Coverage Amount

The coverage amount is the percentage of treatment costs, after the deductible, that your mental health insurance policy will cover.

Prior Authorization (PA)

Most insurance providers require prior authorization, or certification, before entering the program and continuously throughout treatment. We will guide you through this process as well. Consequently, if your policy has this stipulation, we will provide you with support and direction on how best to proceed. If you don’t see your insurance provider in the list above, that does not mean that we cannot work with them— it might simply mean that we haven’t worked with them previously.

Deductible

Your deductible is an annual amount that you must pay before insurance will begin to cover your expenses. Typically, once the deductible has been satisfied for the year, your mental health insurance policy will start to cover a percentage of the total treatment costs, called the coverage amount.

Maximum Out of Pocket (MOOP)

The MOOP is a limit on your policy set by your insurance company. Once the total amount of coinsurance paid equals the MOOP, the insurance policy typically covers 100 percent of the “allowed amount.” Sometimes, the deductible applies toward the MOOP, which can help you meet that limit faster.

Out-of-Pocket Expenses

Your out-of-pocket cost is the amount you must pay each time you visit a doctor or receive inpatient, outpatient, or other treatments. These costs are usually due at the time treatment begins, but you may also be able to pay them a little at a time with payment plans. Out-of-pocket expenses include deductibles, copays, and co-insurance.

Managed Care

This blanket term describes the primary system through which healthcare services are provided in the United States. An insurance company directs—i.e., manages—how you receive treatment, from regular checkups to accidents to major illnesses. Managed Care Organizations (MCOs) include the doctors, hospitals, laboratories, and clinics that make up your network.

Single-Case Agreement

A Single Case Agreement is a customized contract between BestMind and your insurance carrier, allowing out-of-network providers to be treated as in-network. In some cases, this is an opportunity to receive advanced and specialized services based on need and circumstance. We have significant experience negotiating Single Case Agreements with insurance companies to ensure that individuals receive comprehensive and high-quality behavioral health treatment. Our goal is to facilitate access to the best care possible.