Is Kartini Clinic contracted with my insurance company?
Kartini Clinic has and will continue to make every effort to contract with insurance carriers who support evidence-based eating disorder treatment. But even if we are not contracted with your insurer on a permanent basis we can work with you to secure a Single Case Agreement (SCA). SCAs can often provide the same level of coverage as your regular policy.
As of Nov 1, 2015 Kartini Clinic is a preferred provider (aka "in network") with the following insurance plans:
Caremark MHN PPO
Cigna Behavioral Health
GOBHI (Greater Oregon Behavioral Health)
Kaiser Permanente NW
MHN (the behavioral health subsidiary of Health Net)
PacifiCare Behavioral Health
PacificSource (PPO) and PacificSource CCO (Medicaid)
Regence BlueCross BlueShield of Oregon (and all out-of-state "Blues")
Trillium Health Plans
United Behavioral Health
Even if your insurance plan is not listed here, please contact our intake coordinators. In many cases it is possible to secure a "single case agreement" to cover treatment at Kartini Clinic, especially if there are no viable treatment alternatives in your insurance plan's network. For insurance questions, please call 971-319-6800 and speak with our intake coordinator.
What eating disorder treatment does my plan cover?
We will contact your insurance company and request a summary of your eating disorder treatment benefits. We will provide you with a written summary of the information given to us by your insurer and provide you with an estimate of your out- of-pocket treatment costs (if your carrier is not contracted with Kartini Clinic).
We always recommend you verify any information given to you; insurance companies have been known to give inaccurate information to providers. As you ultimately will be responsible for any outstanding balances, it is essential you satisfy yourself that all benefit information is accurate and up-to-date.
What if my insurance carrier says I need to seek treatment elsewhere?
This is a common problem. All insurance companies have financial relationships with certain providers (aka “preferred providers”). Unfortunately these financial relationships have little to do with the quality of care and everything to do with the cost of treatment (to the insurance company). It will depend on you and your primary care doctor to determine what is the right care for your child.
When choosing an appropriate eating disorder treatment program it is essential to remember that not all such programs are appropriate for children, regardless of what insurance carriers say. You should always insist on a program with specific expertise in treating children. You should also insist your child attend a facility that treats eating disorders exclusively, not simply as another diagnosis among many (e.g. so-called “dual diagnosis” clinics). Otherwise your child may be treated alongside those with addictions and severe behavioral issues. This is not an appropriate environment for a child or young adult with an eating disorder.
Our intake coordinator can assist you and your primary care doctor to ensure that insurance carriers do not make inappropriate treatment recommendations for your child. Call us at 971-319-6800 and speak to our intake coordinator to get the process started.
How do I take care of treatment authorizations and claims?
Our clinical staff will obtain any treatment authorization(s) required under your insurance policy, provided your insurance company has given us accurate information regarding such authorization requirements.
Kartini Clinic will file all of your claims directly to your insurance company. You should receive from your insurance company an Explanation of Benefits (EOB) detailing any payments made directly to us on your behalf. If you do not receive EOBs within 30 days of receiving treatment, please contact your insurance carrier immediately. Insurance carriers are required to furnish you with information within 30 calendar days of your appointment.
How will I know how much treatment costs?
We will provide you with a written estimate based on the best available information about your insurance policy. Please bear in mind, virtually every insurance plan these days will require you to pay a substantial deductible and co-insurance, regardless of where you seek treatment.
We make every effort to work with families to meet the cost of treatment. In most instances we will ask for a partial deposit prior to the start of treatment, but our business office will do everything possible to find suitable financial arrangements. Please call our intake coordinator at 971-319-6800 if you have questions about payment.
Kartini Clinic offers financing through American Healthcare Lending. We do so solely as another option to families. Kartini Clinic has absolutely no financial interest in loans made through AHL. Applications for financial assistance can also be made through the Kartini Foundation. You may find more information and obtain an application form here.
What do I do if my insurance carrier won’t help me?
The name of the game is persistence. Insurance companies are far more responsive if they know you are going to advocate relentlessly for your rights and/or those of your child. After all, you are the paying member, and at the end of the day you are the only person who can ensure that you get the benefits you are entitled to.
If you have any questions, call your insurance carrier right away, and don’t get off the phone until you are satisfied your question has been answered! Here are a few tips when talking to insurance companies:
Tip #1: when talking to insurer carrier representative, be sure always to get a name and, if possible, a direct line or extension number. At the very least they have to provide you with a reference number of the call. Be sure to take notes, and don’t be afraid to ask for a supervisor if you are not getting the answers you need. You are also within your rights in Oregon to record any call to which you are a direct party.
Tip #2: we recommend that every Kartini Clinic parent and/or patient seek a care manager. A care manager is a single point of contact between you and your insurer. Such a person will know your name and the particular requirements of your case. A care manager will be able to help with authorizations for treatment as well as with claims that are either denied or paid incorrectly. If asked why you want a care manager, you may inform them that Kartini Clinic recommended you seek one because of the potentially intensive (and expensive) nature of eating disorder treatment. Each step in the process usually accesses separate benefits (e.g. medical, behavioral health) within your plan. Most insurers do not have enough trained staff to ensure your claims are looked at by someone who understands this. And be prepared for them to say no, but keep asking! In the end your persistence is likely to pay off.
Tip #3: If you get your insurance through your employer, talk to your employer’s benefits manager or HR person. Insurance carriers are often much more responsive to employers, who, after all, are the ones ultimately purchasing the insurance.
Most importantly, don’t give up! We have seen many, many families successfully challenge insurance carriers to get the vitally needed eating disorder treatment their child needed.
The following are some sources for further insurance assistance:
Oregon’s Department of Consumer and Business Affairs, consumer information and complaints. Or call 503-947-7984.
National Eating Disorder Association Insurance Parent Tool Kit. The information here was compiled from research by ECRI Institute and the experience of parents and treatment providers who have had experience obtaining coverage for eating disorders care.