While we work with most private insurance companies at Prosper Treatment Center, we cannot guarantee authorization of treatment, approved level of care or length of treatment. Unfortunately, authorization of treatment is fairly subjective and we are ultimately at the mercy of how the payor interprets medical need for an intended patient.
With that being said, we have an amazing team of professionals who have the necessary experience to obtain the maximum authorized days for treatment.
1.) First, we analyze your policy to determine the member benefits. To verify benefits, please click here.
2.) Once we process your insurance policy, we will review the member benefits; these include whether or not your policy covers out of network providers such as Prosper Treatment Center. We also verify your deductible, out of pocket maximum, type of treatment covered, and the co-pay. From here, we will be able to establish a basis of coverage and begin the process for obtaining treatment.
3.) Payors utilize what is referred to as “medical necessity” to determine the number of days for authorized treatment with a particular level of care. Generally speaking, payors qualify a patient for medical necessity on the basis of substance abuse or mental health.
4.) As a client progresses through treatment, medical necessity becomes increasingly difficult to prove. Eventually, your payor will deny continued insurance coverage based on their set of guidelines that they use to interpret medical necessity. Again, we will do our best to prove medical necessity so that we can maximize authorized days of treatment.
5.) As we take this journey together, we hope for the best possible outcome. We realize that this decision was made with great consideration for the welfare and benefit of your child. We want you to know that we are going to do our very best to promote an environment of consideration, love, and healing with an amazing team of professionals.