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08 . 22 . 19

Insurance questions? Shelterwood has answers.

By Shelterwood

Shelly Moss knows that there is a lot of anxiety and heartache on the other end of her phone line. By the time parents call Shelterwood, they have tried many other options to get their struggling teen help. They need hope, and they need it fast. 

What they do not need is the extra stress of navigating a complex, confusing and often impersonal insurance industry. Shelly helps make that journey easier by walking parents through the residential treatment insurance process.

During the admissions process, Shelterwood helps families clarify: 

  1. Is residential treatment medically necessary for your child?
  2. What does your insurance policy cover?

Most policies will only cover medical necessities: Families need to show insurance providers that residential treatment is not just preferred, but needed. How do you prove necessity? 

The first step is completing the free, no obligation Shelterwood application. A multidisciplinary team reviews applications to make sure residential treatment—and Shelterwood’s unique program—is a good fit. 

Second, parents should gather documentation for all the previous treatment their child has undergone, including therapists’ notes, test results, outpatient or partial hospitalization records, and letters from any professionals who can speak to the necessity of residential treatment for the child. This step is critical. 

“The most important thing to establish that you’ve exhausted all options at home,” Shelly says. “Documenting everything you’ve tried before Shelterwood will build the case that residential treatment is medically necessary for your child.”

Shelly says parents should ask themselves two questions: 

  • Have we tried everything we can at home? 
  • Can we keep our child safe at home? 

Any professional documentation that shows, yes, we have tried all other options, and, no, the child is no longer safe outside a residential program will help prove medical necessity to an insurance provider. 

Third, parents need to call their insurance provider and authorize Shelterwood’s request for a verification of benefits. Shelterwood will call the provider to find out current policy details, including if there is anything that can prevent coverage (including behavioral-health, out-of-network or residential exclusions) and if they require accreditation for reimbursement. (Shelterwood is accredited by the industry-leading Joint Commission) Within 48 hours, Shelterwood typically is able to talk parents through their insurance coverage options, so families know what may be covered before they enroll.

Finally, Shelterwood will file with the insurance company. “We handle whatever the insurance requirements are,” Shelly says, including medical necessity documentation, pre-authorization, regular updates and appeals when necessary. Shelterwood takes care of the paperwork so families can focus on their healing.  

Shelly emphasizes that second step really makes the difference. “What I really emphasize to families is the importance of gathering information on all the previous treatment routes that have been  tried in the past,” Documenting the path that lead to Shelterwood can help insurance providers agree to cover treatment here.  

Do you have insurance questions? Or just want to know more about how Shelterwood can help bring hope to your family? Call our admissions office to learn more.