Laurel Heights is a private acute hospital and intensive residential treatment center located in Atlanta, Georgia that treats children and adolescents with complex psychiatric and behavioral problems. These include mood disorders, self-injurious and aggressive behaviors, and difficulties with impulse control and emotional regulation. By providing a highly structured, secure and supportive therapeutic environment, individualized treatment by a multidisciplinary staff and fostering family involvement in all aspects of treatment, we build on strengths to help each child develop needed skills to function more successfully in the community.
Thank you for your interest in Laurel Heights Hospital. Our admission process begins with two steps. First, we obtain clinical documentation from current and recent treatment providers, considering what is available. No particular information is required, but we need enough documentation to show what the child’s diagnosis is, their level of functioning and the recent behaviors that warrant the need for residential treatment.
Once we receive enough information, our Medical Director will review the clinical within one business day to determine if we are an appropriate program to meet the child’s needs. Then, if clinically approved, we will contact the child’s insurance company to determine the requirements to have residential treatment authorized. Please feel free to contact our Admissions Department with any questions and/or concerns.
To make a referral, contact the Admissions Department to begin the process.
Laurel Heights Hospital is contracted with most private insurance companies, managed care organizations, Georgia and Tennessee Medicaid as well as a number of state agencies and school systems across the country. As a specialty hospital, we are often able to negotiate agreements for most out of network providers in many circumstances.
When you call, we will ask you to provide the following information:
Referrals for residential treatment at our behavioral health facility may be submitted by parents/guardians, physicians, social workers, therapists, hospital staff, inpatient psychiatric facilities, schools, court liaisons and members of the clergy.
An initial telephone contact is acceptable; however, a written packet of information is required before the admission process can proceed. The information we need includes:
Many families have questions about how private insurance coverage applies to their child’s treatment at Laurel Heights Hospital. If the patient’s insurance plan includes coverage for behavioral health inpatient or residential treatment, insurance coverage for admission and a continued stay at Laurel Heights is based on the insurance company’s guidelines for “medical necessity” of treatment. You can typically find these guidelines on your insurance company’s website.
Your insurer might be Blue CrossBlue Shield, Aetna, Cigna, United Health Care, Value-Options or another company. Since each state’s Medicaid program is designed differently, we encourage all parents and/or guardians to contact Laurel Heights Hospital to receive information on your Medicaid coverage regarding treatment.
If your insurer authorizes admission, they will specify the number of days they will initially approve. Generally they authorize a short period of time initially, which prompts a clinical review shortly after admission so that the insurance company’s care manager can obtain information about our assessment of the patient’s condition and the patient’s initial response to treatment. For acute inpatient treatment, insurers may authorize an initial period of one to three days. For residential treatment, insurers often grant seven days, sometimes more, sometimes fewer. At the end of this initial period, Laurel Heights will review the patient’s progress with the insurer. This is called “concurrent review” and is completed by our Utilization Management Department.
If the insurer determines that the patient meets their “medical necessity” criteria for continued treatment, they will authorize coverage for an additional period of time. The review process will continue like this throughout the patient’s stay at Laurel Heights.
For residential treatment, some plans specify a maximum number of days they will cover, provided that the patient continues to meet the “medical necessity” or continuing stay criteria established by the insurance plan. We encourage parents to understand their insurer’s definition of medical necessity and any requirements the insurer has around family participation in treatment.
We will keep you updated on your child’s progress and will work with you to coordinate a smooth transition home with needed support services. The care manager from the insurance company is often a great resource in identifying additional community-based services to ensure a successful transition. At some point in the utilization review process, the insurer may determine that the patient is no longer or close to no longer meeting their established criteria for inpatient or residential treatment. We will notify you if this is the case. If we believe that there is additional information that could change that determination, we will ask your insurer to schedule a peer review. During a peer review, the patient’s psychiatrist at Laurel Heights will review the patient’s progress with the insurer’s psychiatrist. Based on this review, additional days may be authorized.
If additional days are not authorized, your insurer will deny payment for continued days of treatment at Laurel Heights Hospital. If this occurs, we will notify you as an appeal may be filed with your insurer. Our clinical staff will notify you of the denial and discuss the treatment staff’s recommendations. If you wish to continue your child’s treatment at Laurel Heights in spite of the insurance denial or during the appeal process, you will be referred to the Business Office to discuss private-pay options.
The appeal process may go through several levels. It may take two to three days for each level of appeal, and up to 30 days for an independent review done by a psychiatrist independent of your insurer. Your insurer might reconsider their denial. If this occurs, the denial is overturned. The insurer will make payment for all the days previously denied and will specify how many more days of treatment will be authorized for payment. The concurrent review process will continue.
If the insurer’s denial is upheld, you will have two choices. Either the patient can be discharged to continue treatment in outpatient care as recommended by the insurer, or you can continue the patient’s treatment at Laurel Heights with the private-pay arrangement.
You may disagree with your insurance company’s final determination and you have the right to challenge your insurer’s decision. At your request, we may be able to assist you. You can also express your concerns to your employer’s benefits office.
We hope the above information gives you a better understanding of how your insurance works and sets your expectations about inpatient or residential treatment. Please do not hesitate to contact us for additional information.
Laurel Heights Hospital’s professional staff are ready to help find the best treatment options for your child. Call 404-888-5475 for a no-cost, confidential assessment 24 hours a day, 7 days a week. If you need immediate medical assistance, contact 911 or seek the nearest emergency room.