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/Behavioral Health portion of your insurance, not the Medical portion.
The Johns Hopkins Hospital East Baltimore Campus and the Johns Hopkins University Physicians participate with Medicare and Medical Assistance of Maryland. An Admissions Coordinator will be able to give you information regarding participation with your specific plan. As a reminder, regulations also require us to bill for Medicare’s deductibles and co-payments, although we participate.
Please note that we are out of network with Medicare Advantage plans, other than the Johns Hopkins Advantage MD plans, and out-of-state Medical Assistance plans.
The patient is responsible for providing all insurance information to the Psychiatry Admissions Office. Because benefits vary according to insurance, employer group, and individual plans, the Business Office would have to verify all insurance coverage to determine estimated liability.
Worker's Compensation Cases
If your medical bills are being handled by a Workers’ Compensation insurer, you will need to schedule a consultation with our Consult Clinic. The Consult Clinic’s Coordinator can be reached at 410-955-2343.
If you are referred to the inpatient program, please provide the Admissions Coordinator with contact information for your Workers’ Compensation company or case manager. The Admissions Coordinator will contact a Workers’ Compensation Representative to arrange for reimbursement and contracting. This contract must be completed and signed by all Workers’ Compensation representatives as a prerequisite for eligibility.
Prior to your Admission
The first step in the process is to provide the Admissions Coordinator with all of your insurance information. As a courtesy, our Business Office will then attempt to verify benefits and the Admissions Coordinator will 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 benefits our office has provided, 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 your liability, based on an average length of stay for our program. You will be asked to provide these payments on the dates of admission to the inpatient and day hospital programs. Once the insurance company(s) pays the facility and professional fees, if the balance exceeds the original estimated liability, you will be billed for the remaining amount. Regulations also require us to bill for deductibles and co-payments, even for those insurances with which we participate.
Please note that we have a two part billing system in the Department of Psychiatry at Johns Hopkins. Our facility fees and professional (doctor) fees have different billing practices and participation with insurers. For that reason, one of these entities may participate with your insurance, while the other may not. Coverage for both of these will be verified by our Business Office.
On the Day of Admission
If your insurance policy requires authorization for treatment, the Admissions Coordinator will attempt to obtain this upon your arrival. PTP admissions are billed under inpatient mental health benefits and are subject to the insurance companies criteria for mental health treatment. In most cases, we cannot obtain authorization prior to your date of admission. Commercial insurances and medical assistance will require authorization, also called precertification.
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, bank transfers and all major credit cards as methods of payment. Please note that if you are paying cash, we will need to direct you to our cashier’s office to make payment. Credit and debit cards are the preferred method of payment. Please contact your credit card company or banking facility regarding large payments or balances.
A Note on Authorizations: We are usually successful in obtaining 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. A payment to cover three to four of inpatient fees would be required if you choose to be admitted.
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 made a payment at admission, it will be applied to this cost, but you may need to make additional payments. 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.
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.