Health Insurance FAQs

Health Insurance FAQs

What does ‘covered service’ mean?

If a service is ‘covered’ by your insurance that means it is included in your benefits. Those benefits also determine the portion of out-of-pocket cost associated with the service.

What does it mean if something is excluded from my insurance plan?

If a service is excluded, it is not included in your benefits. You may choose to pursue that service and pay for it yourself.

Why aren’t my benefits a guarantee of payment?

  • Insurance companies will tell you: “Benefit quotes are not a guarantee of payment. Payment is determined at the time a claim is received.”
  • The Emily Program checks coverage for all of our services against your benefits as accurately as possible; however, many client-specific variables will impact your benefits once a claim is sent. These variables include: Diagnosis code, length and frequency of visits, service location and treating provider.

Why can’t The Emily Program tell me exactly how much my treatment will cost?

The total cost of treatment is determined by your benefits at the time services were provided. This includes network status, out-of-pocket payments made year-to-date, insurance pricing for these services, and The Emily Program’s contract with each insurance company. These factors (among many others) affect how a claim is processed and paid by insurance – and with this many variables, it isn’t possible to provide estimated total out-of-pocket costs with accuracy.

What does it mean when a service requires authorization?

Insurance may require additional permissions (authorizations) be obtained by The Emily Program before services can be provided. Authorizations for service generally are obtained by The Emily Program prior to the service being rendered.

  • While the authorization must be approved for the service to be covered, an authorization does not guarantee coverage for a service. If you want to know for certain whether a service is covered, you must talk with your insurance provider.
  • Insurance payment is determined at the time a claim is received and decisions are based off medical necessity.

What is “Coordination of Benefits” and what do I need to do?

“Coordination of Benefits” is an annual requirement for all insurance companies to determine if additional insurance coverage exists. If dual insurance coverage does exist, Coordination of Benefits will determine which plan is primary, and which plan is secondary. If Coordination of Benefits is needed on your plan, all services billed will be denied and you will be responsible for 100% of the amount owed.

  • Call your insurer and inform them if you have additional coverage (e.g. a secondary insurance company.)

What’s the difference between primary and secondary insurance?

When dual-insurance coverage exists, one of the plans identifies as primary, i.e. the ‘first in line’ to pay for your healthcare services. The other will identify as secondary. Services are billed to both insurance plans prior to deductible or co-insurance costs being billed to the client. Call your insurance provider to have Coordination of Benefits set up with both plans prior to claims being processed through insurance (see above).

Can my services be billed differently to accommodate a better benefit level?

The Emily Program submits claims to insurance based on the service rendered, the amount of time for each service, the medical information required (i.e. diagnosis code), and the contract we have with the insurance company. Claims cannot be adjusted to accommodate your benefits.

  • Patient responsibility amounts are determined by your insurance company, not The Emily Program.

For additional questions and information regarding your benefits, please contact the Customer Service Line on the back of your insurance card.

Please call The Emily Program Client Accounts Team with questions regarding the services you have received, clarification on your statement and payment plan options: 1-888-364-5977, ext. 1357.

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What Will Your Insurance Pay?

What will your insurance pay?

Step one: Call your insurance provider

You and your loved ones are the best advocates for your own benefits. The Emily Program will contact your insurance company for a general quote of benefits after scheduling your intake appointment, but to determine how much of the cost of your care you are responsible for, you must contact your insurance provider personally.

Our insurance verification tool will help guide you through this conversation. This tool includes everything you will need to have ready for the phone call to your insurance company to get an estimate of your insurance benefits while you are at The Emily Program.

If you continue to have trouble receiving adequate coverage from your insurance company or if you’re unclear on the terminology, please read our:

If you are unable to get the information you need, another option is to call your insurance company’s ‘Health Advocate’ or ‘Case Manager’ department. These insurance representatives are dedicated to helping you understand and navigate your benefits. (Look for a phone number or other contact information on the back of your insurance card.)

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Current Insurance Providers

Current insurance providers

Note: This list is subject to change. Please use our insurance verification tool and contact your insurance company for coverage details. The Emily Program works with the following insurers, so you receive the highest level of benefits.

Remember to bring your insurance card with you to your appointments.


Minnesota

  • America’s PPO
  • BlueCross BlueShield
  • Group Health Cooperative (GHC)
  • HealthPartners
  • Humana/LifeSynch
  • Medica/United Behavioral Health/Optum
  • Medical Assistance
  • Medicare
  • MMSI/Mayo Health Solutions
  • PreferredOne
  • SelectCare
  • South Country Health Alliance
  • UCare

Ohio

  • Aetna
  • Anthem BlueCross BlueShield
  • Apex Health Solutions
  • AultCare
  • Beacon Health Options
  • CareSource
  • Cigna
  • Humana/LifeSynch
  • HealthSmart
  • Molina Healthcare
  • Medical Mutual of Ohio
  • Mutual Health Services
  • Ohio Health/Optima Health
  • OSU Health Plan
  • SummaCare
  • UnitedHealthcare/Optum

Pennsylvania

  • Highmark
  • UPMC

Washington

  • Aetna 
  • Amerigroup
  • Asuris Northwest Health
  • Cigna
  • Community Health Plan of Washington
  • Coordinated Care*
  • First Choice Health Network
  • GAIP
  • Kaiser Permanente
  • Molina Healthcare
  • Premera BlueCross
  • Regence BlueShield
  • United Behavioral Health/United Healthcare/Optum
  • UHC Community Plan*

*In-network coverage in King County


If The Emily Program is not “in-network” under your insurance policy, you may be able to utilize out-of-network benefits. Not all insurance companies cover all services, so be sure to check with your specific insurance policy about coverage.

If your insurance company is not on the list, there may be other options. Coverage may still be available out-of-network or on a case-by-case basis. Call us at 1-888-364-5977, ext. 1612 to start the process.

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What To Expect

What to expect at The Emily Program

When you begin the admissions process, you can expect to speak with a compassionate staff member who truly understands the complexities of eating disorders. We honor your trust in us and we keep everything that you share with us confidential.

Take the first steps toward your recovery

Step 1: Speak with an admissions specialist

If you’ve completed an online request to start the process of scheduling an eating disorder assessment, then we’ll be contacting you soon. Otherwise, please call us at 1-888-364-5977 to speak with an admissions specialist. Your admissions specialist will talk with you about what you (or your child) are experiencing, collect some information (name, contact info, insurance information), answer questions, and schedule a phone intake.

Step 2: Complete a phone intake and make a plan

Next, your Phone Intake Therapist/Nurse will call to complete your phone intake at the scheduled time. Following the phone intake, your Clinical Admissions Specialist will make a level of care recommendation, help set up any necessary medical assessments, and schedule a program start date. 

Step 3: Start programming

On your first day, you will receive an expanded intake assessment, participate in orientation, and then begin treatment.

Note: Please see our COVID-19 policies for information on what to expect.

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Get Started

Get Started

That first phone call or email to The Emily Program feels huge. We know. Many of us have been there, too. That’s why our team walks with you through the eating disorder assessment and eating disorder treatment process, explaining the details and answering questions every step of the way. You can do this.

How It Begins: Our Admissions Process

How it begins:

Our admissions process

Our simple admissions process begins with an eating disorder assessment. (We accept self-referrals and provider referrals from across the country and around the globe.) If you have questions about insurance coverage, refer to our Insurance resources.

To begin the eating disorder assessment process, take a moment now to complete our online form or call our admissions team 7 days a week at 1-888-364-5977.

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