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.
Due to varying insurance network limitations, not all providers at The Right Door for Hope, Recovery and Wellness are in-network with the insurances listed. This list is not a guarantee that The Right Door for Hope, Recovery and Wellness providers are in-network with these plans. Persons served should always confirm benefits and network provider(s) with their insurance company prior to receiving services. This can be done by calling the customer service number on the back of the insurance card or through insurance company member portals or applications. Prior authorizations and out of network requests should be submitted to the insurance company prior to start of services.
Many plans will pay for out of network services. If the person served chooses to receive out of network services, all out of network deductibles, co-insurances, co-pays and any other out of network charges will be the responsibility of the person served up to their monthly ATP if the insurance company deems the charges as patient responsibility. Persons served must provide updated Coordination of Benefits (COB) information to the insurance company when requested by the insurance company, otherwise, all charges are the responsibility of the person served until the updated COB information is provided to the insurance company. Our office cannot do this on behalf of the person served. Many insurance companies, especially Blue Cross Blue Shield, Blue Care Network and ASR, request this information annually from their members.
ASR Health Benefits, including: Physicians Care Network, Health Alliance Plan (HAP) PPO, Alliance Health and Life (HAL), Benesys Union Trust
Carelon Behavioral Health, including: Health West, New York State Empire Plan, Unicare State Indemnity Plan, General Motors LLC, ValueOptions Commercial Non-HMO
Blue Cross Blue Shield (Traditional, Medicare Plus Blue PPO, PPO Trust, BCBSM Mental Health/Substance Abuse Managed Care Networks)
Blue Care Network (including BCN Medicare Advantage)
McLaren (Medicaid, HMO, Health Advantage)
Medicare Part B
Meridian (including Wellcare) **limited to Med Services staff only
Molina (including Molina Medicare) **limited to Med Services staff only
Physicians Health Plan, (limited to Med Services staff only) including: Sparrow Health Plan, PHP Advantage, Sparrow Advantage, Covenant Advantage, U-M Health Advantage
Priority Health (HMO, PPO, Medicare Advantage, Medicaid)
Tricare East (administered through Humana Military)
Veterans Choice Program/Community Care **Must have authorization letter from the VA prior to services**
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.