Milestones Ranch Malibu Residential Treatment Program proudly provides you with the service of utilization review specialists from Executive Billing Company. These specialists will work in tandem with you to maximize your insurance reimbursement.
We at Milestones Ranch Malibu believe consumers are entitled to support in seeking payment for claims. We believe in Executive Billing Company and the high quality of service they have consistently provided for our satisfied customers. Before proceeding with this service, please take note of the information below.
INSURANCE VERIFICATION & BENEFITS
The first step in pursuing insurance coverage is to complete a verification of insurance benefits. This is conducted prior to admission or, at the latest, within 24 hours of admission, to determine what types of benefits from your insurance carrier apply to our program. If benefits exist for the OUT OF NETWORK RESIDENTIAL LEVEL OF CARE, then we can move forward with the insurance process. Should your insurance policy fail to include out of network Residential benefits and is an exclusion of your policy, there will not be the ability to recoup any money at any time. It is critical to disclose ALL insurance policies covering the client or payment may not be received. Also, it is critical that each policy, if more than one policy, have an updated “coordination of benefits” on file. You can complete a coordination of benefits by calling the member services on the back of your card. Only the insurance carriers can determine which policy is the “primary policy” and it is critical to know which policy is the primary policy for payment.
Upon each verification of benefits, the insurance company states a disclaimer that they do not guarantee payment despite authorization, since it is subject to the plan terms and based on their specific guidelines for medical necessity. While this sounds counterintuitive, it means they are not responsible for reporting the benefits accurately and the case may be reviewed after approved and be denied later.
They also will never disclose how much they will pay per day because Milestones is out of network and not contracted with your insurance company. You and the insurance company are the only two parties contracted for your policy. It is your responsibility to know your policy exclusions and limitations as well as your contract with the carrier.
You may request a copy of your plan contract from your carrier to see what exactly you are entitled to at any time via a request in writing. Your company HR or broker may also be able to provide this information to you upon request.
Any estimates of payment are estimates based on previous data of out of network policies and NEVER A GUARANTEE OF DAILY RATES OR PAYMENT.
In order for Milestones and Executive Billing Company to process your insurance, you must provide your insurance information prior to or upon admission. The insurance process is very time sensitive. Insurance policy cards and information submitted after 24 hours will decrease the likelihood of reimbursement and can incur penalties by the carrier. If you later choose to use insurance for reimbursement, we can provide you with a superbill to obtain reimbursement on your own.
Authorization of Treatment
Our second step is to contact the insurance company with all clinical and medical information. At this time, one of two developments will occur.
- Your insurance carrier grants authorization for treatment. They will allot a limited number of days of treatment, after which they will request more clinical and medical information to determine further authorization. This process continues throughout treatment at Milestones to determine medical necessity to continue to hopefully authorize treatment.
- Your insurance carrier denies authorization for treatment. They will then request a phone review with one of our clinicians. If the denial is overturned, authorization will be granted in the same process as above. Denial of authorization can occur again any time throughout treatment, after which this process will repeat. If in the event that our phone reviews result in continued denial of authorization, we will contact you with the result and options moving forward.
Billing & Claims
Upon receipt of authorization of treatment, we will submit claims to your insurance carrier every 7 – 14 days. It typically takes insurance carriers approximately four weeks to process the claims. If they provide payment, it is typically issued within 60-90 days of admission in order of which the claims were submitted. They may also request medical records which can delay the process and can be used to deny previously authorized days. Again, authorization is not a guarantee of payment as they state is their disclaimer.
Milestones and Executive Billing Company cannot control how much treatment and what type of treatment your insurance carrier authorizes, if they will issue payment, and how much payment they will issue. If payment is not acceptable to you, you can dispute the amount of payment with your carrier directly. Unless your carrier processed the claim incorrectly, Milestones and Executive Billing Company is not eligible to dispute the amount of payment issued by your insurance carrier. Insurance decides what they will pay for the services.
Milestones receives the same letters from insurance as the policyholder. Payments and corresponding paperwork from your insurance carrier may be issued to the policyholder directly. Please mail all payments and corresponding paperwork you receive to Milestones, so they may process the payments. As noted on your financial agreement, an 8% fee is deducted from each payment issued by the insurance carrier to cover costs of insurance billing and utilization management, billing, appeals and collections. Should you receive payments directly from the carrier, please understand the 8% remains and remains due for services.
What is not billed for by Executive Billing Company
Executive Billing Company only bills for the Residential treatment level of care while at Milestones. Medical services, psychiatric services, labs and pharmacy services are not billed and is excluded from the above process.
Changes to Insurance Policy During Treatment
It is your responsibility to notify Milestones Administrative Staff immediately if your insurance policy changes. This includes a change in policy ID number within the same insurance carrier, new policies with a different carrier, etc. Claims, payments, authorizations, and appeals will be significantly compromised on the carrier’s end if Milestones is not notified immediately (prior to or within 24 hours of change).