Health Insurance

Helpful Information for Patients and Families

McLean OCDI Houston is a self-pay treatment program, therefore we do not accept payment directly from third-party providers (e.g., insurance or loan companies) unless a single case agreement is in place.

While we are a self-pay program, our patients often utilize insurance for payment reimbursement or work with their insurance company to secure a single case agreement.

For questions about utilizing your insurance for our program, please call our office manager at 832.900.1271.

Insurance Reimbursement

Families can contract with SJ Health Insurance Advocates, a company that assists families in receiving reimbursement from their insurance companies (reimbursement varies based on individual’s plan/policy) for a small fee.

We recognize that the nuances of managed health care and the claims submission process can often be difficult to navigate and understand. These frequently asked questions may help you to minimize confusion and maximize insurance reimbursement.

Frequently Asked Questions

What is SJ Health Insurance Advocates?

SJ Health Insurance Advocates, LLC (SJHIA) is a New Jersey based company that specializes in behavioral health insurance authorization and claims management. McLean OCDI Houston offers the option of utilizing insurance services through SJHIA to help patients obtain reimbursement for treatment. You may visit their website at www.sjhia.com.

McLean OCDI Houston provides all required information to SJHIA in order to utilize insurance benefits. In turn, SJHIA will verify and communicate to the patient such information as whether the patient has coverage for treatment, whether such coverage includes out-of-network providers, plan deductible, and out of pocket limits.

Who will answer my questions about insurance benefits and authorizations?

We strongly encourage you to contact SJHIA prior to treatment at McLean OCDI Houston to discuss your specific insurance coverage. A consultation with SJHIA will provide answers to the many questions that arise regarding insurance benefits, along with advice on what approach will best serve the patient.

To contact SJHIA, please call 973.740.0023 and ask for Janice Colmar or Alfredia Hackley. You can also contact them via email. Tell them that you are calling about McLean OCDI Houston.

What happens if services are approved?

SJHIA will contact the patient’s insurance carrier within the first 24-48 hours of admission. If intensive outpatient services are approved, SJHIA will provide that information to the patient and/or their representative. SJHIA will also continue to work with McLean OCDI Houston and the patient’s insurance company to complete ongoing reviews (typically every 5-7 sessions). SJHIA will continue to complete the authorization process until either services are denied; or the patient is discharged.

In addition to obtaining insurance authorization, SJHIA manages the claim submission for services rendered. Specifically, SJHIA will submit claims for authorized services, at the daily rate, to the patient’s insurance carrier upon completion of treatment.

Please note that it may take a minimum of 30-45 days for the patient’s insurance carrier to process the claim.

What happens if services are denied?

If/when services are denied, SJHIA will complete a provider appeal, which is called a “doc-to-doc” or “peer review.” This process entails SJHIA reviewing information about the patient with the insurance carrier’s doctor to further advocate for authorization of services. At that time, treatment will either be approved and reviews will continue; or treatment will be denied, and no further reviews will take place. SJHIA will communicate with patient and/or their representative regarding any denial.

Will SJ Health Insurance Advocates continue to appeal for coverage and reimbursement?

SJHIA will not continue to appeal for services following a denial on a “doc-to-doc” review. If you are interested in discussing your member appeal options, you can feel free to contact SJHIA for additional information or guidance.

When can I expect to receive payment for services?

McLean OCDI Houston is an out-of-network provider, thus claims often take slightly longer to be processed. As mentioned above, claims can take approximately 30-45 days to process.

How much money I will receive back if claims are approved?

SJHIA can provide some guidance around your reimbursement, based upon your specific policy and the typical allowed amounts. Please feel free to reach out to SJHIA to discuss your individual case.

In order to maximize the patient’s insurance benefits, the decision to utilize SJHIA’s services must be made within the first 24-48 hours of admission due to the time sensitivity in dealing with insurance.

Need More Information?

Please contact us should you have any additional questions regarding the insurance reimbursement process.