(919) 335-5053 [email protected]

Day Treatment/IOP Billing

Day Treatment/IOP Billing Magic

Billing an IOP either as In Network (INN) or Out of Network (OON) can be very tricky. We are here to help assist with the process.

We are INN with Aetna so we can manage most of the claims for you. How we do that:

  1. We reach out to your insurance and submit for authorization
  2. We get a verification of benefits from your insurance
  3. We submit claims to your insurance for you
  4. We charge you based on the co-pay indicated on the verification of benefits

Aetna

Tricare Logo

We are an Out of Network Participating provider with Tricare. This means you can be reimbursed by Tricare for much if not all of your child’s treatment. Similar to Aetna we:

  1. We reach out to your insurance and submit for authorization
  2. We get a verification of benefits from your insurance
  3. We submit claims to your insurance for you
  4. We charge you the full fee and have Tricare reimburse you directly

We are INN with Cigna

Cigna Insurance In-Network Logo

Blue Cross Blue Shield of North Carolina In-Network Provider

We are INN with BCBS for outpatient services in December 2023

    We are OON with all other insurance companies.
    While we can not guarantee the amount of reimbursement, which is determined by your insurance, clients typically are reimbursed at some level. Depending on your insurance it could take a few months after discharge to see your entire reimbursement, and we can help you navigate the system as much as possible while being limited as an OON provider.

    OON based upon insurance:
    BCBS-pays all services directly to you when you submit the charges yourself
    Cigna-pays all services directly to you when you submit the charges yourself
    United Healthcare-only reimburses on a per diem basis. This means they lump all charges into one payment and only reimburse you for your group sessions.

    We help you with billing in the following ways: 

    1. We reach out to your insurance and submit for authorization
    2. We give you superbills and claims on either a CMS 1500 or a UB04 based upon your insurance company
    3. Our office manager, Emily is here to answer questions
    4. We provide you with language to ask your insurance important questions directly, such as: 
      • What is my out-of-network deductible for IOP mental health services?
      • How much of that deductible has been met to date?
      • What is my out-of-network coinsurance percentage (if any) after my deductible has been met?
      • What is my out-of-pocket maximum for out-of-network services?
      • How much of that has been met to date?

    We allow Single Case Agreement for BCBS and Cigna as we are in the process of becoming in network with both.

    What we offer: 

    • In person IOP runs MWF or TRF 3:30-6:15/6:30 (We have an online version coming that will run 4:30-7:30pm MWF)
    • Day Treatment MTWRF 3:30-6:15/6:30
    • Parent groups-Tuesday 5-6pm —you are welcome to keep coming to this group for free even after your teen leaves treatment
    • Individual and family — to be scheduled on the off days than IOP so we can bill your OON benefits and you get reimbursed (2 services can’t be billed on the same day) unless you have UHC/UBH as they don’t reimburse you for either
    • We highly encourage family and individual sessions in the course of our treatment. Teens don’t struggle alone. Support for the whole family system are needed to make change. Therefore, we offer a reduced rate of individual and family sessions while in IOP (listed below)
    • Check ins – Clients check in with their lead intern individually once a week during group time

    When you are paying out of network, we expect payments on the Monday of the week of group.
    IOP Rates:

    IOP group 3 days per week (group is 3:30-615/6:30), 15 minute weekly check in, and 60 minute parent support and skills building group

    In this you receive your individual and family outside of STO (we strongly discourage this as the best results we have are with those who receive their individual and family in our program. It can reduce the amount of time your family is involved in our program)

    • Rate: $250 per day =$750 per week
    • IOP group 3 days per week with either individual OR family being provided at Simply Teens
      • Rate: $250 per group day, $75 per individual/family session weekly = $825 per week
    • IOP group 3 days per week with both individual AND family being provided at Simply Teens
      • Rate: $250 per group day, $75 per individual session, $75 per family session = $900 per week
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    Day Treatment

    We charge date treatment rates a bit differently. We can not bill groups and individuals for insurance even OON on the same day so we bundle the payment into one to charge.

    When a person needs 5-day a week care, we require family and individual sessions to be done with our team. We have had the best results when we use the following formula and see significant progress made during our time limited program.

    Day Treatment Rates:

    • All IOP services at the family and individual rate: $900 per week
    • And 2 more days of group at $250 per day rate: $500 per week
    • Total rate: $1,400 per week

    Get In Touch

    Call

    (919) 335-5053

    Email

    Admissions@SimplyTeensOutpatient.com

    Address

    800 West Williams St., STE 203
    Apex, NC 27502

    Hours

    Mon - Fri: 10am - 7pm