Insurance & Fees
Walden Behavioral Care is “in network” with many major insurance/managed care companies. This means that Walden Behavioral Care has a contract with these companies to provide specific services to members through individual benefit plans. All plans have co-payments and deductibles and Walden Behavioral Care requires payment to cover those co-payments and deductibles for which the patient or guarantor is financially responsible.
Walden Behavioral Care also accepts “out of network” insurance arrangements, which means insurance coverage from companies that do not have a contract with Walden Behavioral Care. Typically, “out of network” insurance will cover only a fixed percentage of the total hospital charges. The patient or guarantor will be financially responsible for the remainder of the charges. Walden Behavioral Care requires a deposit, prior to admission to cover these anticipated charges for which the patient or guarantor is responsible.
Insurance companies require a demonstration of “medical necessity” before they will authorize treatment, even though the treatment is a benefit covered under the member’s contract. Our admissions team will assess “medical necessity” and make a recommendation about treatment. If the insurance company agrees with our recommendation the admission will be approved, including the type of service and the number of days authorized for your care. If the insurance company disagrees with our recommendation, they will deny the admission and recommend an alternative level of care. In these situations, the Walden clinician will request an appeal of the decision. This appeal may take days to complete. In such cases, you may elect to pay for the admission recommended by Walden Behavioral Care. A deposit will be required prior to admission. If the insurance company overturns the denial, we will promptly refund your deposit.
If your insurance company has a contract with Walden
Walden Behavioral Care contracts with most major insurance/managed care companies. However there are member responsibilities that the individual’s plan requires, such as co-insurance, deductibles and non-covered services and exclusions that will be the financial responsibility of the member/subscriber/guarantor. A deposit will be required for services not covered under your plan at the time of admission.
If your insurance company does not have a contract with Walden
Walden accepts out of network arrangements with insurers who do not have contracts with Walden Behavioral Care. The out of network insurance covers only a fixed percentage of the total program charges. The member has a higher out of pocket responsibility for out of network arrangements. You or your guarantor will be responsible for the remainder of the charges. This financial responsibility will be determined prior to admission and a deposit will be required to cover these non- covered charges.
In some instances when Walden is the only provider for a proposed treatment, your insurance company may provide an individual agreement which will waive the out of network status. Walden staff will obtain that agreement if it is available to you.
If you are paying for treatment yourself
Patients who receive services that are not covered by insurance will be required to sign a letter indicating they or their guarantor are responsible for payment of all fees.
In all cases where services are not covered by insurance, a letter must be signed by the patient or their responsible party indicating that they assume responsibility of payment of all non-covered services.