With a diagnosis supporting medical necessity, insurance plans often cover behavioral health services. As a courtesy to our families, CASE Inc. will run an eligibility and benefit verification for our families to provide an overview of your behavioral health benefit prior to beginning services.

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In-Network Insurance Carriers

Our network status is changing as we become contracted with more carriers. Some of the insurance carriers we currently have contracts are listed are:

• Aetna

• Anthem Blue Cross

• Autism Services Group (ASG) / Beacon Health Strategies

• Blue Shield / Magellan Health Care

• Tricare / ECHO

• OPTUM / United Behavioral Health (UBH)

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Out-of-Network Insurance Carriers

CASE Inc. will bill out-of-network carriers; however, we highly recommend verifying out-of-network benefits prior to scheduling.

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Medi-Cal / Medicare

CASE Inc. does not bill Medi-Cal directly. Instead, we can bill a Managed Health Group we are in-network with. Below are some Managed Health Groups we have contracts with:

• Care 1st

• Community Health Group (CHG)

• Managed Health Network (MHN)

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CASE Inc. does not bill Medicare

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Friends Club

As of May 1st, 2016, CASE Inc. is no longer billing insurance for Friends Club. If you wish to seek reimbursement for Friends Club, CASE Inc. will send you a copy of your paid invoice. Our invoices are insurance friendly, and you can use them to submit to your insurance carrier for reimbursement.

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Things to Consider

• Autism Diagnosis

  • To cover services, many insurance carriers are now requiring a diagnosis of Autism to be less than 2 years old. If the diagnosis is more than 2 years old, a letter confirming the diagnosis from a primary care provider or referring physician is required annually (and some carriers biannually!)

• San Diego Regional Center (SDRC)

  • Changes in Federal Laws – Medi-Cal

    • According to new Federal Laws, Medi-Cal considers behavioral health treatment a covered benefit for individuals under age 21 with a diagnosis of Autism.

    • Beginning February 2016, SDRC is no longer covering behavioral health services and is requiring families to utilize their insurance benefit for funding.

    • Click this link for additional details

  • Copay Assistance

    • Deductibles, copays/co-insurance responsibilities are costly! SDRC offers copay assistance for families who qualify. Contact SDRC at (858) 576-2996 for more information.

  • Insurance Denials

    • In the event insurance doesn’t cover, SDRC often times will help cover services. A denial letter from your insurance is required. Please contact SDRC at (858) 576-2996 for more information.

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If you have any questions about your insurance plan, please contact our office at 760-720-4964 and ask for our Insurance Department.