We have gotten many phone calls from people who have had a family member who was in an inpatient drug and alcohol rehab facility that did 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 the services up front. Since they do not participate with the insurance, they need to make sure they will be paid. The only real way for them to ensure payment is to get it in advance. Again, due to the situation, the family has no choice so they borrow, or charge, or whatever they need to do at the time. 

A lot of times their insurance will have out of network benefits available and the patient (or family member with the insurance) can get reimbursed. The problem is that the facility does not submit the claims. They usually provide the patient with a ‘walk out’ statement, or some other form that shows the charges.  

The insurance companies usually require that the charges be submitted on a UB04 form, which is the universal claim form for facility billing. It isn’t that they don’t want to pay, but the information that they require is not on the walk out statement that the facility has provided to the patient. The facilities don’t know how to complete these UB04 forms, and they’ve already been paid. Many times they truly want to help the patient get reimbursed but they simply don’t know how. If you find yourself in this situation, the first thing you must do is to contact your insurance company and find out if there are out of network benefits.



Source by Michele Redmond