Insurance verification before admission is a critical step.
For the patient, it’s a guarantee that the insurer will cover a chunk of the expenses. This way, they can actually focus their energy on treatment without worrying about the bills.
For the treatment center, on the other side of the equation, the verification of benefits is reassurance that they’ll be reimbursed for their services.
The accredited Long Island Treatment Center, located in Hicksville, offers free insurance verification.
How We Verify Your Insurance
Verification should be a straightforward process. At Long Island Treatment Center (LITC), we try to keep it as quick and simple as we can, using an insurance verification form.
Naturally, we need your name and contact info. But we also need insurance-specific details, such as your insurance provider, their toll-free number, your member ID, and the group number.
The reason we collect this information is to look up your insurance benefits. So, try to fill out as many fields as possible.
Optional Step: If you’d like, you could leave us a note describing your situation and your treatment preferences as well.
When you’re done filling out the form, submit the response. Someone from our admissions department will get in touch with you soon after.
This would be a good time to inquire about:
- Whether LITC is an in-network treatment center for your coverage.
- The range of behavioral health services covered by your plan.
- Whether you’ve met your deductible.
- What (if any) copays or coinsurance you have to cover.
- What pre-authorization is needed for treatment.
Factors Affecting Your Substance Abuse Treatment Coverage
Both the plan type and category (metal level) can significantly affect your out-of-pocket costs and the amount of freedom you’ll have when choosing a rehab center.
Plan Type and Coverage Level
The common plans out there are the Health Maintenance Organization (HMO), the Exclusive Provider Organization (EPO), the Point of Service (POS), and the Preferred Provider Organization (PPO).
Maybe you picked one over the other because of the premiums. For instance, EPOs tend to have lower premiums than PPOs from the same insurance company.
Regardless of the reasons, you’re already on a plan. So, let’s take a closer look at how the type affects your insurance coverage and verification process:
| Plan Type | Provider Choice | Out-of-Network Coverage | Paperwork Requirements |
| HMO | Limited | No | Low |
| EPO | More than HMO | No | Low |
| POS | Moderate | Yes | Moderate for out-of-network providers |
| PPO | Moderate | Yes | High for out-of-network providers |
Plan Category and Cost Sharing
Marketplace plans can be split into four broad categories labeled as metal levels: Bronze, Silver, Gold, and Platinum.
This categorization doesn’t really have much to do with the type of behavioral health benefits you’ll get. It does, however, have everything to do with the cost-sharing structure.
Check this table for a simplified estimation of your share vs. the insurer’s share:
| Bronze | Silver | Gold | Platinum | |
| Insurer’s Share | 60% | 70% | 80% | 90% |
| Your Share | 40% | 30% | 20% | 10% |
Common Concerns With Insurance Verification
You may be worried about coverage gaps and outright denials. While both can happen, that doesn’t mean you’ve hit the end of the road.
First, you have to consider why your claim might get denied in the first place.
Insurers often clarify the specific reason for denial. But one common reason is that something went wrong with the paperwork. Maybe there was a missing document, a prior authorization delay, or even a simple typo in the claim.
What can you do about it? Appealing the decision is a valid option. You submit a request with the supporting documents (the right ones this time), explaining why this particular service is a medical necessity for your case. Just make sure you do it soon after receiving the claim denial.
If that doesn’t work, you can always consider alternative routes, such as:
- Inquiring about the rehab center’s payment plans and sliding-scale fees.
- Checking the programs funded by the Office of Addiction Services and Supports (OASAS).
- If you’re on Medicare, look into Medigap plans for help paying your cost-share portion.
Admissions Team at Long Island Treatment Center
Experience, compassion, and dedication are keystones of our client care, and this is reflected in how every team member approaches their work.
A prime example is LITC’s director of Admissions, Holynn Johnson.
Holynn entered the behavioral health field back in 2019 as an Admissions Coordinator. Since then, she’s been helping affected individuals and their families navigate the road to recovery.
Gwendolynn Denny, our Admissions Therapist, has been working in the field for 15 years, starting as an administrative assistant. Gwendolynn is also pursuing certification in substance abuse/mental health counseling.
3 Things to Do Before Admission Time
Let us just clarify that our representatives are available round the clock to take your calls, no matter how prepared (or unprepared) you are.
You don’t have to have everything figured out to reach out. In fact, you can call just to learn more about recovery and the available treatment options.
That being said, there are a few things you might want to do before it’s time for the actual admission.
1. Have All the Key Information Ready
As we mentioned earlier, the team will need your basic insurance information (provider name, member ID, etc.).
However, the admission process is about more than just insurance verification.
The team also wants to understand your situation and how they can best help you recover. This means you should be prepared to provide information about:
- Your substance abuse history and patterns.
- A list of drugs you’re currently taking (recreationally or for medical use).
- How the substance abuse affects your day-to-day life (physical dependence, strained relationships, etc.).
- Whether you’ve tried quitting before
- The intensity of the symptoms you experience when you go a while without using.
- Whether you’ve been diagnosed with any physical or mental health condition.
- The family and friends who might be involved in your recovery (along with their contact info).
It’s important to answer as honestly as possible.
Remember that no one is here to judge you. On the contrary, some of us are in recovery ourselves. We’ve been where you are right now, and we know it’s a tough spot. But we’re here to help you get through the early stages of recovery.
For instance, hiding the fact that you have a co-occurring mental health issue can hinder your treatment. After all, integrated care (addiction treatment simultaneously with mental health treatment) is vital for people with dual diagnosis.
2. Take a Closer Look at the Facility
It’s normal to wonder about the state of the facility where you’ll receive treatment and potentially even stay for weeks.
So, feel free to take a virtual tour of the premises. Alternatively, you can come in for an actual tour. Just contact our team in advance to schedule a visit.
3. Do Your Due Diligence
Checking out the amenities and facility conditions is good. But what’s even more important is evaluating the quality of care.
To do so, we recommend looking at state licensing, staff credentials, and client reviews.
Take Long Island Treatment Center for example.
Our Hicksville center is an OASAS-certified Part 822 facility. We are also recognized by the Joint Commission for our behavioral health services.
As for personnel, we have dual board-certified doctors, psychiatrists, and licensed counselors on the LITC team.
The list of qualifications held by our staff includes Licensed Mental Health Counselor (LMHC), Credentialed Alcoholism and Substance Abuse Counselor (CASAC), Licensed Creative Arts Therapist (LCAT), and Fellow of the American Society of Addiction Medicine (FASAM).
FAQs
What treatment services are covered by insurance?
Under state and federal law, policyholders have the right to access detox services, residential treatment, outpatient care, and medication-assisted treatment as long as they’re deemed medically necessary.
How much you’ll have to pay out-of-pocket, however, may vary.
Just note that treatment options that are considered investigational, such as ketamine infusions for depression, are typically not covered. Experiential services, such as rapid detox, are often not covered as well.
Can I request insurance verification even though I’m not the policyholder?
When filling out our insurance verification form, make sure to select “a friend or family member” under “Who Needs Help?”. Our team will get back to you to see how we can assist your loved one.
Note that Long Island Treatment Center works with professional interventionists. So, we can also help you deal with your loved one’s denial and resistance, as well as provide you with the resources needed to transition from the intervention to treatment.
Do you accept Blue Cross Blue Shield?
We accept a wide range of healthcare insurance plans, including Blue Cross Blue Shield. Reach out to our admissions specialists to verify your benefits.
Start Your Streamlined Admissions Process
As overwhelming as it may seem, getting admitted into a treatment program can be the life-changing step you need.
Take the first step by contacting us, and our admissions department will guide you out of the insurance coverage maze.