Insurance and Fees for Treatment

Fairwinds Treatment Center participates in several insurance and managed care company plans, which enables our facility to provide specific services to the patient through his/her individual plan. Fairwinds requires payment, prior to admission, for any applicable deductibles and co-payments. Co-Insurance, (the percentage of payment not covered by the insurance company), is due before discharge.

Insurance companies usually cover inpatient treatment if the patient meets the “medical necessity” criteria set forth by his/her plan. In some cases, however, insurance companies will not cover residential treatment, a “step-down” level of care from inpatient. Some companies will cover a portion of residential care; for those that will not, our staff will help you determine the benefits available through your plan and will try to obtain authorization to use the benefits that may apply. A deposit will be required for treatment in those cases where residential care is not covered by insurance.

Fairwinds Treatment Center also accepts some plans in which we do not participate, and there is an "out-of-network" benefit. These insurance plans usually cover only a percentage of the total charges. The patient and/or guarantor will be financially responsible for the remainder of the charges. Fairwinds Treatment Center requires a deposit, prior to admission, to cover these anticipated charges. In some cases, the insurance company will agree to do a “Single Case Agreement” with Fairwinds. In these cases, a rate is negotiated, a contract is signed, and the insurance will consider those individual cases as “in network” and reimburse accordingly.

Before the insurance company will authorize, the patient must meet medical necessity criteria. When the insurance company determines that the patient meets the criteria for "medical necessity," they will authorize treatment, usually a few days at a time. Though the treatment is a benefit covered under the member's plan, this process still must take place prior to admission. Our Admissions staff will assess for "medical necessity" and make a treatment recommendation. If the insurance company agrees with our recommendation, the admission will be approved, including the type of service and the number of days authorized for your care. If the insurance company disagrees with our recommendation, they will deny the admission and recommend an alternative level of care. In such cases, the patient may elect to proceed with the admission, at which time a deposit will be required.

A deposit may turn out to be more or less than the ultimate charges for which the patient is responsible. Any excess will be refunded once the insurance pays their share and all applicable co-pays, deductibles and co-insurance have been applied.

Fairwinds Insurance Contracts

Below is a list of companies with whom Fairwinds participates. If you do not see your company on this list, please contact our Admissions staff; you may have out-of-network benefits, or your insurance company may be willing to do a Single Case Agreement. Please note: not all of these contracts include our Eating Disorders Program. Contact Fairwinds directly to inquire about our participation status for this program.