Financial Responsibility for Mental Health Services
County residents who are Medicaid enrolled, Medicaid eligible or who are uninsured, can receive services which are medically necessary as determined by clinical assessment.
At the time of your first scheduled visit to The Right Door for Hope, Recovery and Wellness you will meet with our Benefits Specialist who will review with you the financial information you have been requested to bring and will establish your ability-to-pay. This is done to be sure our services are affordable. Your ability-to-pay is determined based on your income and family size. Fees are assessed on a sliding fee scale established by the Michigan Department of Health and Human Services. Any deductible or co-pay you may be responsible for will not exceed your Ability-to-pay.
If you are a Medicaid recipient, the benefit specialist will verify the type of Medicaid you have. If a “deductible” amount must be satisfied before Medicaid pays, the benefit specialist will be able to discuss this and answer any questions you may have. In some cases you may be asked to contact your HMO directly for service authorization.
If you have private insurance, The Right Door for Hope, Recovery and Wellness can assist in coordinating your mental health benefits with your insurance carrier. Questions about deductible and co-pays can be answered by the Benefits Specialist.
Redetermination of Ability-to-pay
You have the right to contest an ability-to-pay determination that has been made by The Right Door for Hope, Recovery and Wellness. You can notify The Right Door for Hope, Recovery and Wellness in writing of your desire for a re-determination and a meeting will be held concerning your request. If you are dissatisfied with the outcome of the meeting, you may appeal the redetermination of the ability-to-pay to the Probate Court in the county where you reside.
Annual Determination of Insurance Coverage and Ability-to-pay
The Right Door for Hope, Recovery and Wellness will annually determine your insurance coverage and ability-to-pay if you continue to receive services. A new determination will be completed if The Right Door for Hope, Recovery and Wellness is informed of a significant change which may affect your ability-to-pay and/or insurance coverage.
Frequently Asked Questions
How are you protected?
You can ask for a new determination if your finances change and you feel that you cannot make payments. You also can ask for a review of your determination if you do not agree with the amount you are asked to pay. The law requires that we recalculate the amount you must pay each year if you or family members are receiving services. You can discuss your situation with a Fiscal Specialist if you are having problems with your payments.
What if I still feel I can’t pay the amount you say I must pay?
After finding out how much we determine you can pay, you can ask for an administrative hearing. This request for a hearing must be a written request and must be sent, within 30 days of the original fee determination, to The Right Door for Hope, Recovery and Wellness Fiscal Department. If you still believe this amount is more than you can pay, you can take your case to the probate court in the county where you live.
Is the information I provide confidential?
Yes, all information will be held in the strictest confidence. You may be asked to sign a release of information form that will allow us to provide information to your insurance company.
What if I still have questions about making payments or how my ability-to-pay was figured?
You can contact The Right Door for Hope, Recovery and Wellness Benefit Specialist at 616.527.1790.