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The Pain Treatment Programs understands that health care can be expensive, and that understanding benefits can be difficult. We hope that the following section will help to answer many of the questions we frequently receive about insurance and billing, and will help you make educated decisions about your treatment options.
Admission to our program is a mental health admission through the Johns Hopkins Hospital Department of Psychiatry and Behavioral Sciences and will be authorized under the mental health portion of your insurance, not the medical portion.
PRIOR TO YOUR ADMISSION
The first step in the process is to provide the Admissions Coordinator with your insurance information. As a courtesy, our Business Office will then attempt to verify and explain your insurance benefits as they apply to our program. Please keep in mind, our explanation or quote of your benefits is NOT a guarantee of bill payment; we are only repeating the benefit information that was provided to us by your insurance company representative. If you would like to verify the information we received, or have any further questions about your benefits, please contact your insurance company directly.
Many insurance policies do not cover 100% of the costs of your treatment. Our Business Office will estimate the minimum cost to you, based on an average length of stay. You will be asked to provide these amounts in the form of deposits on the dates of admission to the inpatient and day hospital programs. Please bear in mind that if the final cost after insurance pays their part exceeds the minimum cost estimated for the purposes of calculating your deposit, you will be billed for the difference.
ON THE DAY OF ADMISSION
A few procedures with respect to your insurance will occur on the day of your admission. If your insurance policy requires pre-authorization for treatment, the Admissions Coordinator will attempt to obtain this upon your arrival. PTP admissions would be covered under inpatient mental health benefits. In most cases, we cannot obtain pre-authorization prior to your date of admission.
Also on the day of admission, you will have an opportunity to meet with a representative of our Business Office, who can answer any further questions you may have about billing, or about your benefits as they have been explained to us by your insurance company. Any required deposits will also be collected at this time. We accept cash, checks and all major credit cards as methods of payment.
A Note on Pre-Authorizations
We are usually successful in obtaining pre-authorization from your insurance company when required. However, sometimes insurance companies deny our initial requests for admission. If this happens, we usually recommend that you enter the inpatient program for a few days so that our team can further evaluate you and, using additional clinical information, appeal the insurance company’s decision whenever possible. In these cases, we are usually successful in obtaining authorization through the appeals process.
In the rare instances when our appeal is denied, you may then choose either to stay in treatment as a self-pay patient, or to leave the program. In either case, you would be held financially responsible for the treatment you have received. If you paid a deposit on admission, it will be applied to this cost. If you are not comfortable taking that financial risk, you may choose to leave the hospital immediately upon learning that the initial authorization request has been denied. If this unfortunate situation arises, we will gladly continue to work with you and your physician to try to overcome the financial and/or insurance obstacles to treatment in the hopes that you could be admitted at a later date.
ADMISSION TO THE DAY HOSPITAL
On your first day of treatment in the day hospital, any deposits required for this portion of your treatment will be collected, along with your housing fee, if applicable.
DURING YOUR STAY
Typically, insurance companies authorize a few days of treatment at a time. Our Utilization Review Department will request continuing authorizations throughout your treatment. If at any time your insurance company refuses to authorize further treatment, you will be informed and the team will discuss your options with you.
A Note on Continuing Authorizations
Please be aware that even if we are successful in obtaining authorization, authorization of treatment is NOT a guarantee of bill payment. Your insurance company may authorize treatment, but subsequently make a determination that your benefits were not adequate to cover the bill. For example, if your plan covers 30 days per calendar year, and you are in the hospital for 35 days, the insurance company may authorize your entire stay, but refuse to pay for the five hospital days that exceeded your plan’s benefit. You are financially responsible for whatever your insurance plan does not cover. Contact your insurance company with any questions about their policies regarding benefits, authorization, and payment.
AFTER YOUR DISCHARGE
You and/or your insurer will receive separate bills from the Physicians and from the Hospital. The Johns Hopkins University Clinical Practice Association (CPA) bills for the physicians fees. The Johns Hopkins Hospital bills for hospital charges.
Depending upon your insurance, you may not receive a bill at all, but instead receive an “explanation of benefits” which will outline what your insurance was charged and what was paid on your behalf.
The Johns Hopkins Hospital East Baltimore Campus and the Johns Hopkins University Physicians participate with Medicare, Medical Assistance of Maryland, and various other insurance companies and managed care organizations. They do not, however, participate with all insurance plans. Our Business Office will be able to give you information about whether we participate with your specific plan. Regulations also require us to bill for deductibles and co-payments, even for those insurances with which we participate.
WORKER'S COMPENSATION CASES
If your medical bills are being handled by a worker’s compensation insurer, you will need to provide the Admissions Coordinator with their contact information. We will then contact the insurer or their representative to arrange for our Guarantee of Payment Contract to be sent to the appropriate party. We require this contract to be completed and signed by all worker’s compensation insurers prior to admission.