The Midwest Center

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FREQUENTLY ASKED QUESTIONS Who can refer to Midwest Center? A parent, mental health professional, teacher, probation office, department of children services, anyone who is involved in the life of a child in need of our services can call for information, tour or free assessment. Will insurance pay for services? We accept most insurance coverage. If you are not sure if your insurance will cover our services, please call us and we can help guide you through the process of insurance certification and benefits eligibility. Our intake office can help coach you through requesting benefits from your employer if applicable. Please read our Insurance/Managed care Troubleshooting Guide for Parents . How does insurance coverage work after admission? If you have an insurance plan that includes coverage for behavioral health residential treatment, admission and continued stay at MCYF is subject to your and your employer’s coverage policy and your insurer’s determination of medical necessity for treatment. Your insurer might be Blue Cross & Blue Shield, Aetna, Cigna, United Health Care, Value Options, or another company. If your insurer authorizes admission, they will specify the number of days they will initially approve. At admission, they often grant seven days-sometimes more, sometimes fewer. At the end of this initial period, MCYF will review your child’s progress with your insurer. This is called “concurrent review” and is completed by our Utilization Management Department. If your insurer determines that your child meets their criteria for continued residential treatment, they will authorize more days-they will tell us how many more. The review process will continue like this throughout your child’s stay at MCYF. The annual number of days specified for residential treatment in your insurance plan may be 30, 45, 60, or more per year. The days provided for by your insurance plan and the days authorized by your insurance company are separate. If your insurer determines that your child’s condition meets their criteria for continued stay, then they will continue to authorize use of the days provided for by your insurance plan. At some point in the utilization review process, your insurer may determine that your child no longer requires care at the residential treatment level of care. They may determine that your child is doing well enough to be discharged to a less intensive level of care such as outpatient care. If we believe that there is additional information that could change that determination, your insurer will schedule a “peer review.” During peer review, your child’s psychiatrist at MCYF will review your child’s progress with your insurer’s psychiatrist. Based on this review, additional days may be authorized. If additional days are not authorized, your insurer will deny additional payment for continued days of treatment at MCYF. If this occurs, an appeal may be filed with your insurer. You will be notified of your insurer’s decision to end their payment of your child’s treatment at MCYF. Your child’s program therapist will discuss this with you, as will our Business Office. The therapist will advise you of the treatment team’s recommendations.

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