INTRODUCTION Thank you for choosing Behavioral Health Network (BHN) as your service provider. BHN’s mission is to help individuals, families, and communities improve the quality of lives for those with behavioral health and developmental challenges. BHN values person-centered recovery and services. In partnership with you, BHN looks forward to helping you reach your goals. Outlined below you will find information regarding participation in BHN services. This includes your shared responsibility with services and our Notice of Privacy Practices. INDIVIDUAL RESPONSIBILITY Insurance It is essential that you provide BHN with complete and accurate insurance information. We ask that you always provide a current copy of your insurance card to BHN for our files. Insurance information is necessary so that BHN can determine what resources you have available to pay for services. It is important to carefully read your insurance coverage booklet that describes what your insurance policy covers and any limitations involved. If you have questions about the coverage, please contact your plan administrator. BHN will make our best effort to inform you of the anticipated fees involved as soon as this can be determined. It is important to remember that health insurance coverage varies and not all services are covered. Since plans vary greatly, even within a single insurance company, it is acknowledged that BHN cannot guarantee your coverage. Ultimately, you as the individual served or guardian are responsible for payment of services rendered regardless of any communications you receive from BHN or your insurance company in efforts to assist you. Payment Guarantee In consideration of the services provided, it is understood that you (not the insurance company) are responsible for full payment of BHN fees, co-payments, deductibles, non-covered services or services which the insurance carrier may determine to be medically necessary” or beyond “not what they determine to be their maximum allowable charges. Services Paid by State Contract When services are fully funded by the Commonwealth of Massachusetts, there are typically no payment obligations. Exceptions include co-pays for some outpatient programs or Charges for Care within residential programs in compliance with state regulations. for Care’ refer to ‘Charges expenses not paid by state funding and intended to cover items like room and board. Assignment of Benefits You give permission to BHN to release any behavioral health/medical information necessary for the purposes of filing and processing an insurance claim on your behalf, to current or future insurance companies. You authorize payment directly to BHN for services received.
INTRODUCTION Thank you for choosing Behavioral Health Network (BHN) as your service provider. BHN’s mission is to help individuals, families, and communities improve the quality of lives for those with behavioral health and developmental challenges. BHN values person-centered recovery and services. In partnership with you, BHN looks forward to helping you reach your goals. Outlined below you will find information regarding participation in BHN services. This includes your shared responsibility with services and our Notice of Privacy Practices. INDIVIDUAL RESPONSIBILITY Insurance It is essential that you provide BHN with complete and accurate insurance information. We ask that you always provide a current copy of your insurance card to BHN for our files. Insurance information is necessary so that BHN can determine what resources you have available to pay for services. It is important to carefully read your insurance coverage booklet that describes what your insurance policy covers and any limitations involved. If you have questions about the coverage, please contact your plan administrator. BHN will make our best effort to inform you of the anticipated fees involved as soon as this can be determined. It is important to remember that health insurance coverage varies and not all services are covered. Since plans vary greatly, even within a single insurance company, it is acknowledged that BHN cannot guarantee your coverage. Ultimately, you as the individual served or guardian are responsible for payment of services rendered regardless of any communications you receive from BHN or your insurance company in efforts to assist you. Payment Guarantee In consideration of the services provided, it is understood that you (not the insurance company) are responsible for full payment of BHN fees, co-payments, deductibles, non-covered services or services which the insurance carrier may determine to be “not medically necessary” or beyond what they determine to be their maximum allowable charges. Services Paid by State Contract When services are fully funded by the Commonwealth of Massachusetts, there are typically no payment obligations. Exceptions include co-pays for some outpatient programs or Charges for Care within residential programs in compliance with state regulations. ‘Charges for Care’ refer to expenses not paid by state funding and intended to cover items like room and board. Assignment of Benefits You give permission to BHN to release any behavioral health/medical information necessary for the purposes of filing and processing an insurance claim on your behalf, to current or future insurance companies. You authorize payment directly to BHN for services received.
Consent-Privacy-Practices-Final-1.docx