Growing up in today’s society is hard for kids. Children may suffer from behavioral or mental health issues that impair their quality of life and research shows that many of these children never get help. Boys & Girls Town wants to help change that by working with parents and managed care companies to provide the highest quality of care for children and adolescents.
For many families insurance mental health benefits are available to cover the cost of residential treatment services at Boys & Girls Town of Missouri. Boys & Girls Town will help families determine if benefits are available for their child. Here is how the process works.
• Parents who are interested in placing their child in a treatment program at Boys & Girls Town and are interested in learning what benefit coverage is available should contact Boys & Girls Town’s admissions coordinator at (573) 265-3251.
• Our admissions coordinator will contact the parent’s insurance company utilizing the information on the back of the insurance card. The admissions coordinator will determine whether the insurance company will cover mental health/substance abuse residential treatment. Any deductible and co-payments outlined in the coverage will be detailed at this step and our admissions coordinator will inform parents of these costs as outlined by the family’s insurance coverage.
• If coverage is available, the next step is to determine whether treatment for the child’s condition meets medical necessity, according to the insurance company’s standard of care. Typically, a child must have a significant impairment in functioning due to a mental health diagnosis, have failed at outpatient and inpatient levels of care, performed poorly at home, school and community, and symptoms continue to worsen, regardless of previous treatment.
• Parents will complete the Boys & Girls Town application, which will provide a detailed clinical history. Parents also will need to sign and send a release of information form to every inpatient and outpatient mental health provider the child has seen in the previous six months. The providers will then fax all clinical information to the admissions coordinator.
• Boys & Girls Town’s admissions coordinator will review all the clinical information and forward the clinical information to the insurance company’s pre-certification department. The pre-certification department will assess the clinical information for meeting the criteria of medical necessity at the residential level of care. If it appears that the child meets the criteria for admission, our admissions coordinator will work with the child’s parents to set a tentative admission date and time. Our admissions coordinator will then contact the pre-admission department at the insurance company and present the child’s clinical information. If the insurance company approves the admission, the child will usually need to be admitted within 24 hours, per most insurance companies’ policies. If the insurance company denies treatment, the parent will be contacted to discuss the option of private pay.
Please feel free to contact our admissions coordinator at any time if you have questions about your insurance coverage or to discuss your child’s need for treatment.