Insurance & Fees For Inpatient Treatment

Walden Behavioral Care is “in-network” with many major insurance/managed care companies. This means that Walden Behavioral Care has a contract with these companies to provide specific services to members through individual benefit plans. All plans have co-payments and deductibles, and Walden requires payment to cover those co-payments and deductibles for which the patient or guarantor is financially responsible.

Walden Behavioral Care also accepts “out-of-network” insurance arrangements, which means insurance coverage from companies that do not have a contract with Walden Behavioral Care. Typically, “out-of-network” insurance will cover only a fixed percentage of the total hospital charges. The patient or guarantor will be financially responsible for the remainder of the charges. Walden Behavioral Care requires a deposit prior to admission to cover these anticipated charges for which the patient or guarantor is responsible.

Insurance companies require a demonstration of “medical necessity” before they will authorize treatment, even though the treatment is a benefit covered under the member’s contract. Our admissions team will assess “medical necessity” and make a recommendation about treatment. 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, it will deny the admission and recommend an alternative level of care. In these situations, the Walden clinician will request an appeal of the decision. This appeal may take days to complete. In such cases, you may elect to pay for the admission recommended by Walden Behavioral Care. A deposit will be required prior to admission. If the insurance company overturns the denial, we will promptly refund your deposit.

If your insurance company has a contract with Walden:

Walden Behavioral Care contracts with most major insurance/managed care companies. However, there are member responsibilities that an individual’s plan requires, such as co-insurance and deductibles as well as non-covered services and exclusions. These will be the financial responsibility of the member/subscriber/guarantor. A deposit will be required at the time of admission for services not covered under your plan.

If your insurance company does not have a contract with Walden:

Walden accepts out-of-network arrangements with insurers who do not have contracts with Walden Behavioral Care. The out-of-network insurance covers only a fixed percentage of the total program charges. The member has a higher out-of-pocket responsibility for out-of-network arrangements. You or your guarantor will be responsible for the remainder of the charges. This financial responsibility will be determined prior to admission, and a deposit will be required to pay for these non-covered charges.

In some instances when Walden is the only provider for a proposed treatment, your insurance company may provide an individual agreement that will waive the out-of-network status. Walden staff will obtain that agreement if it is available to you.

If you are paying for treatment yourself:

Patients who receive services that are not covered by insurance will be required to sign a letter indicating they or their guarantor are responsible for payment of all fees.
In all cases where services are not covered by insurance, a letter must be signed by the patient or their responsible party indicating that they assume responsibility of payment of all non-covered services.

Insurance Accepted by Walden Behavioral Care

Even if your insurance company is not on the list below, you may still qualify for admission into one of Walden’s eating disorder treatment programs.

For admissions information if your insurer is not part of the Walden network, click here. The admission staff will attempt to obtain an individual case agreement with your insurance company. Patients and families can pay for eating disorder treatment privately.

Walden has contractual relationships with the following companies:

Aetna
American Behavioral
APS Healthcare
Blue Cross Blue Shield (local and out-of-state plans)
Beacon Health Strategies (Fallon, BMC, GIC, NHP)
Capital Physicians Group (CDPHP)
Cenpatico
Cigna Behavioral Health
Commonwealth Care Alliance
Consolidated Health Plans
CorpHealth/LifeSynch
Fallon Total Care
Fed Med
Health New England
Magellan
Managed Health Network (MHN)
MBHP (Value Options)
Medicaid – Massachusetts
Medicare Part A
MIT
Multiplan
Three River Provider Network
Tricare North (MHN) (Inpatient and PHP Only)
Tufts Health Plans
Tufts Public Health Plans (Formerly known as Network Health)
United Behavioral Health
United Health Care
Value Options
Well Sense (Adolescent ED Inpatient Only)