If you or a family member is struggling with drugs or alcohol, you’ve got more important things on your mind than your insurance coverage. This is one of the reasons that the team at Valley Spring will verify your insurance policy online with a representative from your insurance company.
By taking a few simple steps, you can get the verification process out of the way and start focusing on your recovery. Please continue reading for important information.
Insurance Verification
"*" indicates required fields
“Valley Spring respects your privacy and will never share your information with anyone else. This form and the information collected are completely confidential.”
Have Questions About Insurance? Hear From Our Chief Financial Officer, Michael O’sullivan.
1. Insurance Verification Process
Valley Spring partners with a wide range of insurance providers. Despite this extensive network, it’s crucial for you to confirm whether your specific plan is accepted and determine the coverage details for your treatment. Although this might seem daunting, our online verification tool simplifies the process, making it straightforward and user-friendly.
2. Coverage Variability
Insurance plans vary significantly in what they cover. Our health insurance verification tool, along with our dedicated team members, provides a preliminary estimate of your in-network and out-of-network benefits swiftly and efficiently. We aim to demystify insurance jargon and help you understand key terms related to your health care plan and benefits.
Key Insurance Terms to Know:
- Deductible: This is the amount you pay out-of-pocket for covered health care services before your insurance begins to contribute. For instance, if your deductible is $2,000, you will cover health care costs up to this amount before the insurance pays.
- Copayment: A fixed amount you pay for a covered service, like a physician’s visit or emergency room trip, which may be required before or after meeting your deductible.
- Coinsurance: After your deductible has been met, coinsurance is the percentage of the cost of a covered health care service that you must pay. For example, if the service costs $75 and your coinsurance is 20%, you pay $15.
- Out-of-Pocket Maximum: This cap on the expense you need to pay for covered services in a plan year. After reaching this limit, your insurance should cover all subsequent covered health care costs.
- Policy Effective Date: The date from which your coverage becomes active. Enrollment must occur either during the open enrollment period or following a qualifying life event, such as marriage or the birth of a child, which triggers a special enrollment period.
By familiarizing yourself with these terms and our verification process, you can navigate your health care coverage more effectively and ensure you receive the treatment you need without unexpected financial burdens.
Frequently Asked Questions About Insurance Coverage
Is this confidential?
Yes – we respect your privacy. This form is HIPAA compliant and we will never share your information with anyone.
How do you verify my health insurance benefits?
We communicate directly with your carrier to verify your benefits so that you have an accurate picture of what is covered. There are also online portals that allow us to verify the level of benefit and if the benefit is active.
Who do I call if I have additional insurance questions?
Phone Number (855) 924-5320 Email [email protected]
In order for insurance to cover the cost of treatment, the insurance company must deem it to be medical necessity. The American society of addiction medicine (ASAM) Criteria’s strength-based multidimensional assessment takes into account a patient’s needs, obstacles and liabilities, as well as their strengths, assets, resources, and support structure. This information is used to determine the appropriate level of care across a continuum.
Understanding The ASAM Criteria Continuum of Care for Adult Addiction Treatment
The ASAM Criteria provides a structured framework for assessing and treating adults with substance use disorders. Developed by the American Society of Addiction Medicine (ASAM), this continuum outlines the appropriate levels of care based on the severity and specific needs of the individual. Below is a detailed explanation of each level within the continuum.
1. Inpatient Care (Level 4)
- 4.0 Medically Managed Inpatient: This highest level of care offers 24-hour nursing and daily physician care for individuals with severe substance use disorders and co-occurring health issues.
2. Residential Treatment (Level 3)
- 3.1 Clinically Managed Low-Intensity Residential: Clients live in a structured environment with support services but at a lower intensity.
- 3.5 Clinically Managed High-Intensity Residential: Offers a therapeutic living environment with more comprehensive services for those requiring structured support.
- 3.7 Medically Managed Residential: Provides residential care with medical monitoring for individuals who need significant medical support.
3. Outpatient/High Intensity Outpatient Treatment (Level 2)
- 2.1 Intensive Outpatient (IOP): This program involves several hours of therapy per week, offering more intensive support than standard outpatient care.
- 2.5 High-Intensity Outpatient (HIOP): These services are more frequent and intense, designed for those who need a rigorous treatment schedule.
- 2.7 Medically Managed Intensive Outpatient: Combines outpatient care with medical monitoring, suited for those requiring intensive care but not inpatient or residential treatment.
4. Standard Outpatient (Level 1)
- 1.0 Outpatient Services: Standard care including therapy sessions, usually once or twice a week.
- 1.5 Outpatient Therapy: Involves more frequent and intensive therapy sessions than the standard outpatient level.
- 1.7 Medically Managed Outpatient: Outpatient services that include ongoing medical management and monitoring.
5. Recovery Residences (RR)
- Recovery Residence: Offers a supportive living environment with peer support in a drug-free setting, typically without formal treatment services.
Each level of the ASAM continuum is designed to cater to the varying intensities of medical and therapeutic needs, ensuring that individuals receive the most appropriate type of care for their specific stage of recovery. This structured approach helps maximize the effectiveness of treatment and supports sustained recovery.
In order for insurance to cover treatment, the patient must meet the medical necessity guidelines outlined by ASAM and accepted by the insurance carrier.
The ASAM Criteria is the most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions. Formerly known as the ASAM patient placement criteria, The ASAM Criteria is the result of a collaboration that began in the 1980s to define one national set of criteria for providing outcome-oriented and results-based care in the treatment of addiction. Many states across the country are using The ASAM Criteria as the foundation of their efforts to improve the addiction treatment system.
Level of care recommendations and treatment plans are developed based on multidimensional patient assessments that consider the patient’s biomedical, psychological, and social needs.
