Finding the right mental health treatment for your child can feel overwhelming, especially when you are also trying to understand insurance coverage, out-of-pocket costs, and what level of care may be appropriate. HillsidesCares helps parents and caregivers in Pasadena, the Greater Los Angeles area, and beyond verify insurance benefits for child and adolescent behavioral health treatment.
Our admissions team can help families understand insurance benefits for residential treatment, partial hospitalization programs (PHPs)/day treatment, and intensive outpatient programming (IOP). During the verification process, we may review your plan information, behavioral health benefits, prior authorization requirements, potential out-of-pocket costs, and next steps.
Insurance verification does not obligate your family to begin treatment. It is simply a first step toward understanding your benefits and whether HillsidesCares may be an appropriate fit for your child’s needs.
Insurance plans HillsidesCares works with
- Anthem Blue Cross
- Blue Shield of California
- Carelon Behavioral Health
- Evernorth Behavioral Health
- Kaiser Permanente
- Optum
- TriCare
Verify your benefits
The fastest way to begin is by completing the secure insurance verification form. Once submitted, the HillsidesCares admissions team can review your information and follow up with next steps.
Families may also contact admissions directly if they have questions, are unsure which level of care their child may need, or would prefer to speak with someone before completing the form.
How mental health insurance verification works at HillsidesCares
Mental health insurance verification helps parents and caregivers understand how their insurance benefits may apply to treatment before moving forward with admissions. At HillsidesCares, this process is designed to be supportive, informative, and as clear as possible for families.
After you submit the verification form or contact admissions, our team may review your insurance information, contact your insurance plan or behavioral health administrator, and help explain your benefits in plain language.
Step 1: Submit the insurance verification form or call admissions
Families can begin by completing the secure insurance verification form or by contacting the admissions team directly.
To begin the benefits verification process, you may be asked to provide:
- Parent or guardian contact information
- Your child’s name and basic information
- Insurance carrier
- Member ID
- Group number
- Policyholder information
- Relationship to the subscriber
- A copy of the front and back of the insurance card, if requested
Submitting the form does not obligate your family to begin treatment. It simply gives the admissions team the information needed to start reviewing your insurance benefits and possible next steps.
Step 2: HillsidesCares reviews your information
Once the form is submitted, the admissions team reviews the information provided. If anything is missing or unclear, a team member may follow up with you.
This step helps HillsidesCares better understand your child’s needs, your family’s insurance information, and the appropriate next step. Families who are unsure whether their child may need residential treatment, PHP/day treatment, or IOP can still submit the form or contact admissions.
You do not need to know the exact level of care before reaching out. The admissions team can help guide the conversation and explain what information may be needed next.
Step 3: Our team verifies behavioral health benefits
After reviewing your information, the HillsidesCares admissions team may contact your insurance plan or behavioral health administrator to verify relevant benefits for mental health treatment.
Depending on your plan and your child’s needs, the team may verify:
- In-network or out-of-network status
- Behavioral health benefits
- Residential treatment benefits
- PHP/day treatment benefits
- IOP benefits
- Deductible
- Copay
- Coinsurance
- Out-of-pocket maximum
- Prior authorization or pre-certification requirements
- Medical necessity requirements
- Behavioral health administrator, if different from the main medical plan
- Estimated family financial responsibility
- Self-pay or Good Faith Estimate options
This information can help families understand what their plan may cover and what questions may need to be answered before treatment begins.
Step 4: We explain coverage, costs & authorization requirements
After benefits are reviewed, the admissions team can help explain the information in plain language. This may include whether treatment may be covered, what out-of-pocket costs may apply, whether prior authorization is needed, and what additional steps may be required.
Some insurance plans require prior authorization or pre-certification before certain levels of care begin. In these cases, the insurance company may review clinical information to determine whether the requested treatment meets the plan’s medical necessity criteria.
Insurance verification is not a guarantee of coverage, authorization, or payment. Final coverage and payment decisions are made by the insurance plan.
Step 5: Families move into clinical screening and/or admissions next steps
If HillsidesCares appears to be a fit, the next step may include clinical screening, referral review, admissions paperwork, or a discussion about the most appropriate level of care.
Insurance verification is only one part of the admissions process. Clinical fit, safety needs, program availability, and level-of-care recommendations are also considered.
Families may be directed toward one of several treatment options depending on the child’s needs, including residential treatment, PHP/day treatment, or intensive outpatient programming.
Insurance verification FAQs
If you do not see your insurance plan listed, you can still submit the verification form or contact the admissions team. HillsidesCares may be able to review your insurance information and help determine whether your plan offers behavioral health benefits that may apply to treatment.
Because coverage varies by plan, the best next step is to verify your specific benefits.
If your insurance plan does not authorize treatment, the admissions team can explain what information is available and discuss possible next steps. This may include reviewing other levels of care, discussing self-pay options, requesting additional information, or helping your family understand what the insurance plan has communicated.
Authorization decisions are made by the insurance plan, not HillsidesCares.
A single-case agreement is an arrangement that may be made between a provider and an insurance plan for a specific person’s care, often when the provider is not normally in network with that plan.
Single-case agreements are not guaranteed and depend on the insurance plan, clinical situation, network availability, and other factors. If this may be relevant to your family, the admissions team can explain what information is available based on your plan.
Some families may choose self-pay instead of using insurance. If you are considering self-pay, HillsidesCares can help explain available payment information and Good Faith Estimate options before treatment begins.
A Good Faith Estimate can help families understand expected charges for scheduled services.
A Good Faith Estimate is an estimate of expected charges for health care services.
Federal guidance explains that individuals usually have the right to receive a Good Faith Estimate when they schedule care at least three business days in advance or when they request one.
Insurance verification is intended to help your family understand benefits before moving forward with care. The information submitted through the verification form is used to review your benefits and support admissions next steps.
The timing of insurance verification can vary depending on the insurance plan, the information provided, and whether follow-up is needed. Some verifications may be completed quickly, while others may take longer if the insurance plan requires additional review or clarification.
To help avoid delays, make sure the information submitted is accurate and complete.
Insurance verification is different from receiving treatment or submitting a claim for services. Verifying benefits is generally used to understand what your plan may cover and what requirements may apply.
However, families should confirm directly with their insurance plan if they have questions about how benefit inquiries are handled.
Billing depends on your insurance plan, the services provided, your deductible, copay, coinsurance, out-of-pocket maximum, authorization requirements, and how the insurance company processes claims.
The billing team can help explain estimated financial responsibility when available, but final payment responsibility is determined after the insurance plan processes claims.
If your child has more than one insurance plan, the admissions team may need information for each plan. Coordination of benefits can affect how claims are processed and which plan pays first.
Families should provide all relevant insurance information during verification so the team can review next steps as accurately as possible.
If your child may hurt themselves or someone else, call 911 or go to the nearest emergency room. You can also call, text, or chat 988 for immediate crisis support. SAMHSA describes 988 as 24/7 support for mental health, substance use, and crisis concerns.
Insurance verification is not an emergency service. If there is immediate danger, seek emergency help right away.