We have received many phone calls from people who have had a family member who was in an inpatient drug and alcohol rehab facility that would not accept their insurance. Of course, when the family member was admitted it was a crisis situation, and there was little choice as to what options were available. In many cases it is actually life or death. They certainly can’t be driving around looking for a participating facility.
The problem is that these out-of-network facilities require payment for services up front. Since they do not participate with the insurance, they must ensure that they are paid. The only real way to guarantee payment is to receive it in advance. Once again, due to the situation, the family has no choice, so they borrow, or collect, or whatever they need to do at the time.
Many times your insurance will have out-of-network benefits available and the patient (or family member with insurance) can be reimbursed. The problem is that the establishment does not file the claims. They usually provide the patient with an ‘exit’ statement or some other form showing the charges.
Insurance companies generally require charges to be submitted on a UB04 form, which is the universal claim form for facility billing. It is not that they do not want to pay, but the information they require is not on the exit statement that the center has provided to the patient. The facilities do not know how to complete these UB04 forms and have already been paid. Many times they really want to help the patient obtain funds, but they just don’t know how. If you find yourself in this situation, the first thing you should do is contact your insurance company and find out if there are any out-of-network benefits.
