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November 5, 2024

Hopewell and the Financial Dynamic

By Savannah Schindelar, Admissions Coordinator

Families considering Hopewell for their loved one’s residential mental health treatment may raise concerns about financial arrangements. We are a nonprofit private pay facility with some limited access to insurance coverage and we understand that long-term treatment may strain the pocketbook. However, we pride ourselves in doing everything that we can to reduce the financial burden.

Insurance Coverage

One of the first questions families ask is whether Hopewell accepts insurance. Due to our average length of stay (6-9 months) and our niche type of care, we rarely see full coverage from any insurance provider. Here is a brief summary of the current options.

• Commercial and Private Insurance: We are in network with Anthem Blue Cross/Blue Shield plans that are not Medicaid. We work to get authorization but coverage is never guaranteed.
• Medicare and Medicaid policies unfortunately do not cover our room, board, and treatment costs. Those policies generally cover individual costs such as doctors’ appointments and medications.

Financial Assistance

Many generous donors and foundations support Hopewell’s programs, and fortunately we are able to offer significant financial assistance to those who are eligible. We ask all families who request financial assistance to fill out an application. We can then determine a percentage reduction to our daily rate, reducing the fees as much as 75%. At present, up to 85% of our residents receive some level of fee assistance in this way.

The Utilization Review Process

As a courtesy, for any individuals who have a commercial insurance provider, we will run a Verification of Benefits. This verification lets us know if a policy offers in- or out-of-network benefits. This is important for those residents who come from outside the state of Ohio, as out of state policies can differ in what coverage they offer for services outside of the providing state.

Families can learn about policy details ahead of time by calling the member services number located on the back of their insurance card. Member services is a great resource for inquiring about facilities that are in network with the insurance plan.

An important takeaway: Due to ever-changing provider/program relationships, we advise families to always check with their insurance provider AND the treatment program they are interested in to make sure this information is the same.

What does authorization entail?

Authorization for insurance coverage is not a guarantee of payment but rather a green light for services that could be covered by the insurance provider. Authorization is pursued within 24 hours of a resident’s admission to Hopewell. A call is placed to the insurance provider’s authorization line. Clinical information is given to the clinical case manager assigned. A determination is made by the clinical case manager on the basis of diagnosis, severity of symptoms, and need for residential level of care.

Upon approval, the insurance provider offers a number of days of treatment. At the end of the authorized days given, another call is made to either pursue further authorization or provide discharge updates to close the case.

Why does insurance provide such limited coverage at Hopewell?

Hopewell provides a residential level of care for mental health, a categorization that is common knowledge to insurance providers. However, most insurance companies are used to levels of care such as 7-10 day stays for inpatient care in crisis scenarios and involuntary admissions, or up to 30 days for stabilization and medication management. Hopewell does not provide these types of care; therefore, discussions with insurance providers often require educating them about our treatment model.

Hopewell offers a very niche, longer-term level of care (up to an average of 9 months) that does not have 24/7 observation, crisis admissions or a related medical component to the program outside of medication management services. Due to this, insurance often finds it hard to justify coverage as we are unique in our treatment for mental health.

Since Hopewell is a unique environment offering independence for our residents, an unsecured campus and freedom to make choices in their treatment plan, insurance will often ask why residents couldn’t simply participate in a Partial Hospitalization Program or Intensive Outpatient services. (Note: These treatment models are non-residential full and half-day programs, which Hopewell does not offer.)

Our clinicians do their best to thoroughly document clinical recommendations for residents. They are careful to explain the need for longer-term participation in our program to help give residents time to improve their living skills in a safe and stable environment.

A Final Word

I am dedicated to pursuing help for individuals who need the kind of residential care the Hopewell offers. The conversations that I have with most clinical case managers on the insurance end revolve mostly around educating about our type of our type of program. Every day I see Hopewell residents benefitting from the care that Hopewell provides. It takes a village, and I am happy to have this role in the community.

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