Program Costs

The Pasadena Villa Network of Services programs offer a comprehensive continuum of residential treatment, day treatment, transitional living and life skills/social mentoring services. The clinical needs of our clients and the length of stay will affect total treatment costs. Length of stay is a highly individualized issue and is dictated by progress toward mutually agreed upon treatment.

The program costs are daily per diem rates. The clinical program daily rates include:

• Room and Board
• Diagnostic assessment and treatment planning
• Social Integration Model program groups and activities
• Individual, group and family psychotherapies

• Specialty clinical groups
• Psycho-educational groups, life skills training, independent living skills training, and social mentoring
• Cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), and EMDR
• Medication management
• Recreational therapy, art therapy, equine therapy (in TN) and expressive arts therapies
• Meetings with the interdisciplinary team
• Case management and discharge planning
• Addictions Assessment, groups and Relapse Prevention Planning
• One year of free aftercare through OASIS: Outreach and Social Integration Service
• Academic assistance, tutoring, IEP coordination and college preparation

Our Client Services Representative will assist you before admission to:

• Collaborate with you to set up a financial plan for payment of services.
• Complete and sign all required financial agreements.
• Coordinate with you and our Utilization Review Specialist to obtain the necessary forms, documents and information needed to bill your insurance, if applicable

Although we do accept insurance, most insurance companies will not cover treatment in our programs. But, we will work with your insurance company on your behalf to seek insurance payment for services.

To verify your insurance or check eligibility through A-Fordable Billing Solutions, click here.

We accept Visa, Mastercard and American Express, as well as personal checks, wire transfers and ACH payments for services.

Our programs are primarily private pay, and the vast majority of our clients pay privately for care. But, we understand that some clients desire to attempt to access insurance funds. In an effort to provide exemplary customer service to our clients and families, we have put systems in place to assist with the process of seeking insurance reimbursement.

We are not contracted with any insurance companies or managed care organizations, and services rendered are done so out-of-network.

Given the restrictions, limitations and biases toward mental health treatment, it is highly probable that your insurance plan will not cover any of the costs associated with treatment in our programs. Please be aware that even if you have mental health benefits, there are no guarantees that your insurance will pay for treatment in our programs.

Insurance companies determine eligibility for mental health treatment based on their own criteria for medical necessity. It is imperative that the client, family and/or guarantor, as well as the Pasadena Villa Admissions and Client Services staff, are aware of the criteria applied by your insurance plan. It is extremely important to make yourself aware of the benefit limitations, clinical criteria, and any other requirements that your insurance company may have.

We strongly encourage all clients, families and/or guarantors to directly contact their insurance companies to learn about specific benefit coverage, limitations, and criteria for medical necessity prior to admission.

Our contract is with you and/or the guarantor, and not with your insurance company. As such, the financial guarantor is responsible for all costs of treatment not covered by insurance. All out of pocket and private pay expenses are limited to the approved Self Pay partial scholarship Rates.

Due to the high likelihood that there will be no insurance payments made for our services, it is our policy not to accept full assignment of benefit from any insurance company and a one-month deposit will be required from the financial guarantor.

Even if your insurance company agrees to pay for our services, our experience is that the authorization and claims reimbursement process tends to be a lengthy and often frustrating ordeal. We are happy to do everything we can possibly do to access appropriate insurance funds, but we cannot accept full assignment of benefit, and cannot provide treatment based solely on the hopes that your insurance will pay. 

Please note that no insurance company dictates the length of treatment with us, nor do they dictate the course of treatment. The insurance company decides what, if anything, they will pay for, and they decide when to stop paying, if they ever start. But, the decision to stop paying for treatment by any insurance company does not affect our treatment plan, discharge plan, or the manner in which we treat our clients. Families utilizing insurance benefits must be prepared for the insurance to stop paying at any time. We ask that families be emotionally and financially prepared to continue treatment even if insurance denies payment or stops paying for any reason.

We offer two payment options. The first is a Private Pay Plan with the following highlights:

• Our charged rate is reduced by an administratively approved Self Pay partial scholarship (this applies automatically whenever insurance benefits will not be utilized).
• Full payment of one-month is required at or before admission
• Monthly payments are required during the course of treatment
• The private pay rate is further reduced by an administratively approved adjustment if the guarantor agrees to pay for treatment automatically using either ACH or a credit card on file.

The second option is a hybrid Insurance/Private Pay Plan with the following highlights:

• Payment of one month of the Self Pay partial scholarship Rate is required at or before admission
• We will coordinate verification of insurance benefits
• If there appears to be benefits that could cover our services, our Utilization Review Specialist will take the case and coordinate between us, our external billing company, and your insurance company, to seek the needed authorization and bill for services
• Our Utilization Review Specialist will coordinate concurrent reviews, doctor to doctor reviews, as well as appeals, when necessary, to attempt to receive payment from the insurance company
• The guarantor must make subsequent payments, for the client to be able to continue in treatment while we are billing for services.
• The insurance company will be charged our full charges
• The guarantor’s total potential self pay or out of pocket exposure is limited to our Self Pay partial scholarship Rate, which is the same rate our private pay clients pay.
• In the event we receive payment from an insurance company for days already paid for by the guarantor, we will refund the guarantor if the total paid between the two payers is more than our full charges. If the total paid by the two payers is less than our full charges, there will be no refund.
• Please note that in the event the insurance company denies payment for any reason, or when insurance coverage stops for any reason, the account will be automatically approved for a self-pay partial scholarship, and the financial guarantor shall be responsible solely for our Self Pay partial scholarship Rate, not our full charges.

Clark Behavioral Health Financing offers multiple loan products with convenient qualification. Loans may be approved for all, or a portion, of treatment costs.

www.clarkbhf.com

Serenity Loans also provide loan products to assist with the cost of treatment.

www.serenityloans.com

At times, a family’s resources can be greatly strained and receiving the highest quality of services can be financially difficult. We do offer limited Financial Hardship partial scholarship funds. These funds are provided on a limited basis, and may not be continuously available.

In order to apply for a Financial Hardship partial scholarship, please contact our Client Services Representative, who can explain the process in more detail.

Pasadena Villa is very proud of its track record of providing partial scholarship assistance to families receiving care in our programs.

We understand that families not only have to financially pay for current services, but also need to plan ahead for future healthcare needs. In some situations, specific special needs planning could assist in planning for the unknown. We suggest contacting Legacy Planning Partners, and possibly obtaining a copy of their book Special People Special Planning.

www.legacyplanningpartners.org