We will keep you informed of your child`s progress and work with you to coordinate a smooth transition with necessary support services. The insurance company`s care manager is often a great resource for identifying additional community services to ensure a successful transition. At some point in the utilization review process, the insurer may find that the patient no longer or almost no longer meets their criteria for hospitalization or hospitalization. If this is the case, we will notify you. If we believe there is additional information that could change this provision, we will ask your insurer to schedule a “peer review”. During a peer review, the patient`s psychiatrist in Hillside checks the patient`s progress with the insurer`s psychiatrist. Based on this verification, additional days may be allowed. Sometimes an insurance company may have a “payment with the highest intra-network rate” policy, in which case you cannot negotiate the rate. You always have the option to refuse the SCA if the rate and conditions are not acceptable to you.
If you receive an ACS for a current patient for continued treatment, the negotiated rate is based on the patient`s informed consent and consent at the start of treatment with you. Rate increases will be consistent with your pricing policy in informed consent. You can`t charge the patient a lower mobile rate out of pocket and then charge the insurance company your normal full rate if the SCA is back to cover past meetings. If the patient has recently changed insurance providers, the insurance company may arrange a limited number of meetings (about 10) and a period (for example.B. 60 days from the change of insurance) to allow the patient to continue treatment with the current provider outside the network, while switching to a network provider. If there is evidence that the person could pose a danger to themselves or others, or if it affected the patient psychologically/mentally (e.g.B. If this is necessary to switch to a network provider, it could be made a case of continuation of the offer with the current provider. Examples: a patient has an uncertain bond and it is very difficult to trust others. The already existing therapeutic relationship with the current provider can be considered as a factor in the allocation of sca. For additional organizations, Mirasol representatives will work tirelessly to negotiate agreements on a case-by-case basis and obtain the maximum benefits granted by your insurance company.
If the patient has not had the chance to find a sufficiently qualified network provider, the patient advocates for AA with the out-of-network provider before starting treatment. As an ABA therapy provider, you may want to consider negotiating a single case agreement (SCA) to offer services to a patient. These agreements are concluded between insurance companies and out-of-network service providers (OON) with which the OON Agency is recognized as an in-network network provider .