Livengrin Makes Rehab Payment
in PA Easy
While you can’t put a price tag on health, Livengrin Foundation, a mission based, 501(3)c non-profit, charges fair market prices and strives to offer the best available treatment experience to as many people as possible, regardless of their financial resources. In fact, the Livengrin Foundation board of directors typically awards funding from our revenues for over $1 million per year in scholarship care.
The best and most cost-effective way to deal with addiction is proper and timely treatment. The admissions staff and financial counselor will work with you to obtain coverage and/or financial achieve the best level of care possible.
Check Your Benefits
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Will Insurance Cover Treatment?
The Livengrin Foundation maintains extensive “in-network” partnerships with major insurance companies and managed care organizations (MCOs). This in-network status is only granted to trusted, evidence-based facilities that can demonstrate consistent, high quality treatment, outcomes, and process control at a fair market price.
While you cannot put a price tag on someone’s health, these in-network contract relationships mean you or your loved one will not receive an unexpectedly high bill from an out-of-network facility after your treatment. It also means that you, your employer, or insurance company will be charged fair market rates. As a mission driven non-profit organization, Livengrin provides the best care at the best value so we can help as many people as possible recover.
The best and most cost-effective way to deal with addiction is proper and timely treatment. Our admissions staff is trained to help you understand what co-pays and deductible amounts/limitations are involved with your coverage. Even if you or your loved one is not ready for treatment now, it would be wise to learn about all of your financial options so when the time comes to pursue treatment you are fully prepared. Livengrin can also provide treatment access advice for those with Medicaid coverage or lack of insurance.
Livengrin takes responsibility for evaluating a patient’s medical and clinical needs by using nationally recognized American Society of Addiction Medicine (ASAM) criteria. However, the financial decision is often made by your MCO or insurance carrier regarding the level and length of care.
While our assessment clinicians often agree with these decisions, sometimes they do not. In these cases, Livengrin will appeal their decision and advocate regarding your needs, but the final decision regarding payment is up to the insurance organization. If you disagree with your insurance or MCO payment determination, we can usually provide you with the contact information so that you or your family can speak directly to the insurer. Also, your employer’s benefits manager can often provide useful information about your policy. Although it may be uncomfortable to reveal your situation to this person, it is a small matter compared to the importance of pursuing treatment.
What if I Have No Insurance?
If you or your loved one is battling addiction, and have no insurance, there is help available.
New laws under the Affordable Care Act (ACA) make subsidies available for lower income families that pay most if not nearly the entire premium for a high quality commercial insurance policy. Contact a private insurance broker who writes ACA policies and they can review your financial situation and healthcare needs or visit healthcare.gov to determine if you qualify.
Also, you can apply to your local state to receive a Medicaid policy. In PA, the Medicaid program is called “Health Choices” and coverage is managed by various companies by county. Visit www.healthchoicespa.com to learn more.
If you need treatment today, and have no insurance, you can contact your local “Single County Authority” that is a county agency or commission that receives annual grants to specifically pay for various related drug and alcohol treatment programs. In Bucks County, contact the Bucks County Commission on Drugs and Alcohol: http://www.buckscounty.org/LivingAndWorking/drugandalcoholcommission/DrugAlcoholTreatment
If you do not have insurance Livengrin accepts Visa and Mastercard at time of admission. Call Livengrin, 800.245.4746 and ask for admissions for self-pay rate information and to discuss your options to get into treatment.
Treatment in New Jersey
On February 15, 2017, New Jersey Governor Christie enacted P.L. 2017, Chapter 28, The New Jersey Substance Use Disorder Law, which limits the ability of certain insurance providers to deny coverage for the treatment of substance use disorders when deemed medically necessary by an appropriately licensed professional clinician or doctor. It also regulates prescriptions of opioid drugs. Specifically, this law:
- Requires New Jersey insurers to cover inpatient and outpatient treatment of substance use disorders at in-network facilities
- Puts certain restrictions on prior authorization or utilization management for the first 180 days per plan year of medically necessary inpatient and outpatient treatment of substance use disorders
- Places certain restrictions on prescribed opioids, such as a five-day supply limit on initial prescriptions issued by a New Jersey prescriber
Treatment in Pennsylvania
Insurance coverage regulations are mandated by state law across the United States. In Pennsylvania, addiction treatment is mandated by law. All group health plans, including health maintenance organizations (HMO’s), are required by Act 106 of 1989 to provide coverage for the treatment of alcohol and drug addictions. Also, there are specific parameters for treatment of substance abuse to which insurance companies in Pennsylvania are required to adhere.
The Commonwealth’s Insurance Commission and the State Insurance Department have consistently reaffirmed Act 106, the regulation stating that insurance providers must provide certain minimum coverage for treatment. According to Act 106, a person seeking addiction treatment through insurance coverage needs only a certification of the medical problem and referral by a licensed physician or psychologist. It is the doctor who should determine the patient’s level of care and length of stay in an outpatient, inpatient, or detoxification treatment program.
Currently, managed care organizations (MCOs) outside Pennsylvania often have a say in how much coverage a patient receives – thus determining the amount and length of treatment. Under Act 106, managed care should not play a role in this determination, except to say what treatment facilities are in their network.
Minimum Levels of Treatment per Act 106 in PA:
According to Act 106, all group insurance policies in Pennsylvania must pay for these minimum levels of treatment of substance addiction:
- Up to seven days of detoxification per year (hospital or non-hospital residential), four admissions per lifetime
- Minimum of 30 days of rehabilitation per year, 90 days per lifetime (non-hospital residential)
- Minimum of 30 units of outpatient/partial hospitalization per year, 120 units per lifetime (outpatient/partial hospitalization)
All services must be provided in facilities licensed by the Department of Health to provide alcohol and drug addiction treatment services. Again, MCOs may not overrule the recommendation for length and type of care that is certified by the referring physician or psychologist.
The Livengrin policy is to do everything it can to help a patient receive every medical and therapeutic benefit possible, as mandated by state law, and that is clinically and medically appropriate in accordance with American Society of Addiction Medicine (ASAM) guidelines.
- Supportive Helping patients and their families understand the intricacies of paying for addiction treatment.
- Guidance Counseling available on your insurance rights in Pennsylvania and New Jersey.
- How To Help is available to learn how to gain financial assistance.
We learn about you with a one-on-one meeting with a trained assessment counselor determines the exact nature of the patient's physical and psychological status, and the appropriate treatment to address those issues.
When coming to Livengrin, bring your health-insurance ID card, a photo ID, and the names and phone numbers of your physician and/or other doctors who have seen you, therapist, etc.
A complete list can be found here on the What to Bring pdf.
Livengrin understands that chemical dependency is a disease that affects all members of a family. We place great emphasis on helping families to understand substance abuse and addiction, and to clarify loved ones' roles in a patient's recovery. Very few people can be successful in their recovery without the help of others.
The Family Support page will give you a complete list of all services.
Please remember that it is a patient's responsibility to obtain pre-approval for visitors. Staff will inspect all packages, bags or envelopes. There are specific visiting hours for the inpatient program at Livengrin.
In order to visit, all visitors must attend our "Day of Enlightenment Seminar" that informs and prepares loved ones for their crucial role as part of the patient's recovery.
Livengrin can provide transportation to its main campus from local bus, rail and air connections, medical or other treatment facilities, or other appropriate locations. We are conveniently located near I-95, US 1 and the Bensalem exit of the PA Turnpike.
Every Livengrin location has free parking.
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