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What Are Intensive Outpatient Programs and Who Do They Serve?
Intensive outpatient programs can treat many different issues, including addiction and mental health issues, allowing patients to attend the program while still going about their “regular” life. Intensive outpatient programs may include support groups, group and individual therapy sessions, and life skills classes.
The courses may address issues that lead to addiction and might include self-discovery, emotional regulation, trauma education, relapse prevention, and even vocational skills. In some cases, intensive outpatient programs are used as a “step-down” from an inpatient program, allowing the individual to resume home and school while still receiving the care they need. Intensive outpatient programs are less expensive than inpatient programs, so may be essential for those who have no insurance coverage for inpatient treatment.
What Types of Conditions Require Intensive Outpatient Programs?
The following conditions can require intensive outpatient programs, and individual facilities can cater to specific conditions.
- Opiate dependency
- Alcohol addiction
- Heroin, cocaine, or methamphetamine addiction
- Other substance use disorders
- Bipolar disorders
- Depression
- Anxiety disorders
- Psychotic disorders
- Personality disorders
- Eating disorders
- Self-harm
- Neurocognitive disorders
- Trauma
- Stress-related disorders
Does Insurance Cover Outpatient Programs and Why Are Claims Denied?
In general, many insurance carriers cover the full or partial cost of intensive outpatient program treatment. Even so, not all insurance policies will cover this treatment—and coverage and treatment can vary considerably. Many people who desperately need help for drug addiction or other conditions may not receive the help they need because of an insurance claim denial. An insurer could deny a claim for an outpatient program for many different reasons, including:
- The treatment could be deemed not medically necessary
- An insurer could claim the level of care is not necessary
- Depending on the condition, the insurer could claim the effectiveness of the treatment has not been definitively proven
- The specific services are considered experimental for the condition
- Benefits for the services are not covered under the health plan
What Should You Do if Your Coverage is Denied for Outpatient Programs?
If your insurer covers intensive outpatient programs, yet your claim was denied, you can appeal the decision. Your appeal stands a much better chance of a positive outcome when you work with an experienced insurance claim denial attorney from the Law Offices of Scott Glovsky. Scott and his legal team have been helping people in the same situation for over two decades. Attorney Scott Glovsky never backs down from a fight with a huge insurance company and will zealously defend your rights to treatment.
What Insurance Companies Are Known to Deny Intensive Outpatient Programs?
Any insurance company, including Anthem Blue Cross, Blue Shield, Aetna, Kaiser, Health Net, UnitedHealthcare, and others, can deny a claim for intensive outpatient treatment. If your doctor-recommended intensive outpatient treatment has been denied by your insurance company, you do have options. Your doctor can write a letter to your insurer asking for a medical exception and explaining why the treatment is important to your recovery. While it is easy to feel overwhelmed and hopeless, Attorney Scott Glovsky can help you through this difficult time, helping you obtain the medical treatments you need. Contact Scott Glovsky for a free consultation.
