Mental Health & Autism Health Project HOW DO WE HELP MENTAL HEALTH FACILITIES?

What Services we provide?

At Residential Treatment Centers & Wilderness Programs your top priority is helping the teens and young adults you work with! Wrangling with insurance companies consumes valuable time. We assist facilities in navigating the insurance maze so that you can do what you’re best at—helping youth!

We offer comprehensive insurance services including pre-authorization, ongoing utilization review, billing, appealing denials, and getting you in plan networks. We manage all contact with the insurance companies on behalf of your facility, unless the health plan specifically wants to discuss clinical information with a “peer” (known as “peer-to peer” reviews). Then we advise the treating clinician on how to best engage with the reviewer and what to highlight.

When treatments are denied, we are seasoned experts at handling first and second level appeals, external reviews, and involving state regulatory bodies when insurance companies are not abiding by the law. We are also connected to attorneys in numerous states who work on contingency and will take cases the final round if needed. We prefer to obtain coverage for patients on the front-end, but we have also been highly successful in recovering up to $98,000 for patients on the back end.

We are available for comprehensive insurance services, billing or on a consulting basis. We charge on a contingency basis, depending on the case, or an hourly rate.

Why deal with Insurance at all?

Prior to Federal Mental Health Parity and Addiction Act, which went into effect July 2014 requiring insurance to cover intermediate mental health therapies, few families had the expectation that insurance would cover much if any of their child’s residential, partial hospital, or intensive outpatient treatments. But the climate has changed. Changes in the Affordable Care Act now require that health insurance companies build adequate networks, INCLUDING residential treatment facilities, partial hospital, and intensive outpatient programs. . Now when a family in crisis is looking for an program, they are first considering the facilities that are in-network with their plan. Even the wealthiest of families are now investigating how they can get their health insurance to at least partially cover their child’s treatment.

Facilities that continue to avoid the onerous task of working with insurance will increasingly be left out of consideration when families choose a placement. Families with generous PPO plans will expect that RTCs meet them at least halfway, which includes obtaining pre-authorizations, participating in ongoing utilization review, providing case notes, and supplying insurance ready invoices. We know this sounds like a lot of work. That's why we are here.

Effective Record Keeping & Incident Reports

Incident reports and effective record keeping are critical to continued insurance coverage. When we begin working with a facility, our first step is to clearly explain how to improve record keeping in such a way that will satisfy insurance requirements.

Consultation and Trainings

We provide trainings, in person or via phone or skype, to help your staff work with insurance. We offer trainings on pre-authorizations, ongoing utilization reviews, coding, billing, and following up on obtaining payments.

How do we charge?

Some of our services are available on a contingency basis. We do not charge for an initial consultation, or to review the facts of an individual case. We offer consultation at a flat rate to for profit facilities and discounted rate to non-profits. We also offer services to families on a sliding scale hourly rate.

To discuss working with us, please contact us.

Working with Wilderness Programs

We have worked successfully with several Wilderness programs advising them on how to obtain coverage for their families, doing some of the pre and ongoing authorizations, training staff on insurance billing and authorizations, and handling appeals. Some states have a separate license for outdoor behavioral health, while other states are licensed as residential treatment programs. We have had success working with both types of facilities. We have also had success with appeals and working state regulators in several states. We work with attorneys, who are investigating class action activities, to ultimately end insurance discrimination against this evidence based treatment. The Outdoor Behavior Health Council has obtained a code to use specifically for Wilderness programs, which will go into effect in July, 2017.

Other Info

The U.S. Department of Health & Human Services press release on final regulations for Federal Mental Health Parity.

The Federal government recently issued a report to President Obama taking steps to strengthen insurance coverage for mental health and substance use disorders. The report includes recommendations to bring Medicaid, Tri-Care, the federal government, and local governments in line with Federal Mental Health Parity, and to improve enforcement on the federal level.

MHAIP is here to help. Contact us for more information.

Additional Resources

The Parity Enforcement Project

Kantor & Kantor


We are The Mental Health & Autism Insurance Project

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