Casa Palmera partners with all insurance companies to attain pre-authorization upon admission, and continues concurrent reviews during the treatment stay as the plan allows.
Please contact us and we can help to determine your insurance coverage.
Casa Palmera will work with you to maximize your available insurance benefits. Your insurance plan may cover part or all of your treatment stay, depending on your clinical needs and the medical necessity criteria of your particular plan. Our admissions coordinators will work with you to check insurance coverage and determine the benefits available to you for mental health and chemical dependency services. Insurance benefits vary greatly depending on the policy you have, so it is important that we obtain a detailed quote of your coverage for all levels of care (residential, partial hospitalization, intensive outpatient).
The information we obtain on your behalf from your insurance company will provide the benefits available, but your managed care company still determines the level of care they will cover based on the patient’s presenting problem. The fact that you have benefits available does not mean they will approve treatment since coverage is dependent upon their medical necessity criteria being met at time of admission. Each company has established criteria for medical necessity and we encourage you to contact your provider or go to the provider website to review the guidelines for medical necessity related to mental health/chemical dependency coverage.
For outpatient services, Casa Palmera may be able to call for pre-certification of treatment once you have been assessed and we have clinical information to provide to your insurance company. For residential services, final authorization for coverage will usually occur once you admit for treatment. Since coverage is based on medical necessity, insurance companies do not authorize your entire length of stay upon admission. As our clinical team recommends additional days based on the patient’s progress in treatment, the Utilization Review Department provides updated clinical information to your insurance company. Should insurance deny further authorization, you will be notified immediately so we can determine an appropriate plan for your continued treatment. We will work with you to the fullest extent to get all days authorized possible; however, the final outcome is the decision of your managed care company.