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Day Treatment/IOP Billing | Insurance

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.

Aetna Insurance Logo

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
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
Cigna logo

We are INN with Cigna

Blue Cross Blue Shield Logo

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.

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