Insurance & PQ
How Insurance Works at PQ
PQ has purposefully designed a therapeutic program around the individual needs of your family, not your insurance provider. For this reason, PQ is not in network with any insurance providers and coverage is never guaranteed.
We do find however that in most cases if your plan has good out of network coverage, we are able to gain coverage for some portion of your stay. Here’s how it works: Insurance Fast Facts
Apply to PQ
It all starts with a phone call: 808-937-5806. Our non-commissioned admissions team is ready to answer your questions, learn more about your situation and goals, and discuss options.
Complete a VOB
Once your application is approved, our third party insurance billing company will complete a verification of benefits. This helps us understand the type of benefits that are available to you including what your deductible/coinsurance are and if there are any limitations that may affect coverage.
Arrange Enrollment
Provided we all feel this is a good fit, we’ll book travel, and arrange for enrollment.
Prepayment of Cash Pay rate
PQ will collect a pre-payment of the Enrollment Fee and 45 days of the cash pay daily rate of $1100/day. These funds are set aside to be used for any days that are not covered by insurance.
Pre-Authorization
Shortly before arrival, leveraging the clinical information we’ve learned through the application process, we will request a pre-authorization through your insurance. While this is not a guarantee of coverage, it does allow for us to begin billing your insurance at enrollment.
Enrollment
Our team will inform your insurance provider that you’ve enrolled and begin the claims process.
Continued requests
Generally insurance will only authorize 3-7 days of treatment at a time. We’ll continue to pursue coverage for as many days as possible.
Denial
Eventually, insurance will deny coverage. On average, this occurs between 30 and 45 days into treatment. There’s an option to do a quick appeal (free) and then a more lengthy appeal (Additional fee). We’ll discuss whether this makes sense when that time comes.
Claims Processed & Paid
PQ will begin submitting claims within a week of admission. Sometimes claims can complete processing prior to departure, but more often we see these claims finalize just before or shortlv after departure. Claims are billed in multiple segments for several days at a time.
In most cases, claims are paid directIy to PO. but in some cases. your insurance may send a check to you. If that happens, we ask that you send us a copy of your explanation of benefits (EOB) and a copy of the check so we can calculate your reimbursement.
Reconciliation and Reimbursement
Our 3rd party billing partner collects 10% of all insurance funds collected. You are responsible for the fees on any reimbursement you receive. PQ is also required to withhold your deductible, coinsurance. non-covered services, and state tax. You’ll then be reimbursed for the covered days at the cash pay rate you pre-paid. +rom your insurance carrier, you are required to make payment to Pacific Ouest within thirty days of the check date.
Things to Keep in Mind
- Insurance is complicated! That’s why we’ve partnered with 3rd party partners to ensure the best possible chance for insurance coverage. If PQ hired an internal team to manage the insurance billing, we’d need to increase our fees much more than the 10% Bridgeway charges.
- Because insurance will only authorize a handful of days at a time, we will never know in advance how much coverage your family will receive.
- PQ builds its treatment experience around our families needs, not insurance. This boutique approach to residential treatment requires robust staffing, training, and highly educated professionals to provide safe effective care. The Discounted Cash Pay rate of $895 is not the rate that covers the cost of this kind of treatment. The higher rates occasionally afforded by insurance allows us to offer a reduced rate for families for the days that are not covered. This ensures families can afford a full treatment experience.
- Insurance coverage works by the days covered, not the dollar amount. This means that it’s against the law for us to apply funds from a covered day of treatment to a non-covered day of treatment.
- It’s in our mutual interest to get as many days covered as possible. This lowers your overall cost and helps PQ continue to offer the discounted cash pay rate.
- Due to taxes, bridgeway fees, deductibles, co-insurance and non covered services means that even in the rare event that every day of treatment is covered, you will still have out-of-pocket costs.
