Family Road Map Guide

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Manage INFORMATION
Residential
treatment center
Hospital treatment
Seriously disturbed patients receive intensive and
comprehensive psychiatric treatment in a campuslike
setting.
Patients receive comprehensive psychiatric treatment
in a hospital. Treatment programs should be specifically
designed for either children or adolescents. How
long your child stays depends on his or her condition
and insurance benefits.
Adapted from “Facts for Families: Continuum of Care for Children and Adolescents” fact sheet with permission from
the American Academy of Child and Adolescent Psychiatry. For this and other fact sheets, go to www.aacap.org.
2. What’s AVAILABLE?
Rules of the Road
Be sure to keep the member’s
handbook sent by
the MCO or BHO. (In some
cases, you have to request
a handbook by calling the
customer service number on
your child’s ID card or asking
a case manager.
Read through the “Benefits
Summary” page to get a
basic idea of what the plan
covers. Highlight information
numbers or mark the pages
with sticky notes.
Most MCOs and BHOs also
have the member’s handbook
on the company’s
website. The website address
can usually be found on the
back of the insurance card.
Not all programs and services can be found within every community. These differences
will affect the methods of treatment chosen by your child’s team. However, if
your team can show that services available in another area are medically necessary,
it may be possible to use your child’s benefits to pay for a service that is not available
inside your health system or local area. You may need to get evidence from
your child’s health provider and other sources to support the view that your child
needs to go somewhere else, such as a treatment center or residential program in
another city.
3. What’s COVERED?
Most health plans have exclusions, which are types of treatment that insurance
won’t pay for under certain conditions. You may have to pay a certain amount per
year, called a deductible, before the health plan starts to pay. You may also have
to pay a small amount, called a co-payment or copay, for certain visits. Your plan
may have an annual out-of-pocket maximum, which is the highest amount of
deductible and co-payment charges you are expected to pay in one year. An annual
or lifetime maximum benefit is the most the insurance company will pay for
a particular type of treatment over one year or during the whole time your child is
covered by that plan.
NOTE: In public health plans, co-payments and annual maximums may be
based on your family income. Benefits that are excluded for adults may be covered
for children when the treatment is considered medically necessary.
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