FREQUENTLY ASKED QUESTIONS

Who can refer to Midwest Center?

A parent, mental health professional, teacher, probation office, department of children services, anyone who is involved in the life of a child in need of our services can call for information, tour or free assessment.

Will insurance pay for services?

We accept most insurance coverage. If you are not sure if your insurance will cover our services, please call us and we can help guide you through the process of insurance certification and benefits eligibility. Our intake office can help coach you through requesting benefits from your employer if applicable. Please read our Insurance/Managed care Troubleshooting Guide for Parents.

How does insurance coverage work after admission?

If you have an insurance plan that includes coverage for behavioral health residential treatment, admission and continued stay at MCYF is subject to your and your employer’s coverage policy and your insurer’s determination of medical necessity for treatment.

Your insurer might be Blue Cross & Blue Shield, Aetna, Cigna, United Health Care, Value Options, or another company. If your insurer authorizes admission, they will specify the number of days they will initially approve. At admission, they often grant seven days-sometimes more, sometimes fewer. At the end of this initial period, MCYF will review your child’s progress with your insurer. This is called “concurrent review” and is completed by our Utilization Management Department.

If your insurer determines that your child meets their criteria for continued residential treatment, they will authorize more days-they will tell us how many more. The review process will continue like this throughout your child’s stay at MCYF.

The annual number of days specified for residential treatment in your insurance plan may be 30, 45, 60, or more per year. The days provided for by your insurance plan and the days authorized by your insurance company are separate. If your insurer determines that your child’s condition meets their criteria for continued stay, then they will continue to authorize use of the days provided for by your insurance plan.

At some point in the utilization review process, your insurer may determine that your child no longer requires care at the residential treatment level of care. They may determine that your child is doing well enough to be discharged to a less intensive level of care such as outpatient care. If we believe that there is additional information that could change that determination, your insurer will schedule a “peer review.” During peer review, your child’s psychiatrist at MCYF will review your child’s progress with your insurer’s psychiatrist. Based on this review, additional days may be authorized.

If additional days are not authorized, your insurer will deny additional payment for continued days of treatment at MCYF. If this occurs, an appeal may be filed with your insurer. You will be notified of your insurer’s decision to end their payment of your child’s treatment at MCYF.

Your child’s program therapist will discuss this with you, as will our Business Office. The therapist will advise you of the treatment team’s recommendations. The Business Office will advise you of the cost of continuing care privately.

The appeal process may go through several levels. It may take two to three days for each level of appeal, and up to 30 days for an independent review-done by a psychiatrist independent of your insurer. You will be financially responsible for your child’s treatment at MCYF during the review process.

Your insurer might reconsider their denial. If this occurs, the denial is “overturned.” Your insurer will make payment for all the days previously denied and will specify how many more days of treatment will be authorized for payment. The concurrent review process will continue.

If your insurer’s denial is “upheld,” you will have two choices. Either your child can be discharged to continue treatment in outpatient care as recommended by the insurer, or you can continue your child’s treatment at MCYF with a private-pay arrangement.

You may disagree with your insurance company’s final determination and you have the right to challenge your insurer’s decision. At your request, we may be able to assist you. You can express your concerns to your employer’s benefits office as well.

The above information summarizes how insurance coverage applies at MCYF. We hope it gives you a better understanding and sets your expectations about insurance coverage for residential treatment. Please do not hesitate to ask questions to help better understand this process. For questions regarding insurance you may contact Carol at ext. 202 and for financial questions you may contact Julie at ext. 104.


Will Medicaid pay for services?

Yes as long as it is not package C. The Medicaid criteria for admission is that the child must have had at least 2 inpatient stays at an acute care hospital.

What is the average length of stay?

The average length of stay is five months. Some residents may stay shorter or longer depending on the clinical need. The actual length of stay is determined by the client’s needs and the treatment team.
 

Do we use mechanical restraints or seclusions?

No. We never use any form of mechanical restraints or seclusion. We do use Bridge Building Control Techniques, a unique and comprehensive training program of verbal and physical interventions. This program is to provide for the care, welfare and security of everyone involved in a potential crisis situation.
 

What aftercare programs are available?

If your child was referred by a mental health professional or community mental health association, we will refer your child back to those professionals for aftercare services. Our therapists work with each child’s family to arrange for the most appropriate follow up care. For example, we will help you make an appointment for aftercare services before your child leaves our facility.
 

What should I bring with me to Midwest Center for Youth and Families?

Casual clothing (wash and wear depending on the season). Personal items from home may come with your child. For a complete list see our Parent Handbook.
 

If I need to reach someone on the weekend or in the evening, how do I contact Midwest Center for Youth and Families?

We are open 24 hours seven days a week. Please call 1-888-629-3471 and a staff member will receive your call.