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Title: Anybody have any success with ins. Reimbursement from self pay facility? Post by: dearmschris on December 05, 2016, 01:11:49 PM Hi
My daughter has been in two ARTs and two acute inpatient since October. I am trying to get her into a self pay facility. It's 38,000 a month! They don't work with ins co.s and they don't assist with reimbursement! I have insurance and I'm trying to find a way that my ins co can reimbursement. The director of the facility said that after patients leave, sometimes the families hire someone to review the medical records for insurance reimbursement. Like an accountant or something. Has anyone done this or have any details about this? Thanks so much! Title: Re: Anybody have any success with ins. Reimbursement from self pay facility? Post by: Bright Day Mom on December 05, 2016, 01:24:41 PM I have dealt with my insurance company as we don't have "out of network" coverage. One of my D's needed surgery and I enlisted the top surgeon in the world who specialized in it and doesn't take insurance any way. It took a bit of time, but I worked with my husbands benefits administrator and was able to negotiate a one-time only agreement.n They did not cover 100%, but did cover a large portion of it.
Do you live in the US? Only reason I'm asking is it appears many of our states have programs which cost $0 out of pocket. Title: Re: Anybody have any success with ins. Reimbursement from self pay facility? Post by: PaulaJeanne on December 05, 2016, 02:01:22 PM We have United Healthcare which after a $3,000 deductible covers 70% of out of network expenses. The facility my daughter is using doesn't take any insurance but gives me receipts that have their TIN, NPI # ( I don't know what that is, but they provide it), Diagnosis code, procedure code, Name & address. When I go onto the UHC website there is a section for mental health claims. I go there, click on submit a claim, and enter all the required information. They send me a check.
Hope that is useful. Good luck. Title: Re: Anybody have any success with ins. Reimbursement from self pay facility? Post by: dearmschris on December 05, 2016, 07:44:12 PM We have Aetna. The problem seems to be that the faciity is self pay and doesn't work with insurance companies for reimburement. They issue a bill but no diagnosis code. The facility will not send anything to the insurance company. I'm in Massachusetts.
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