If you’re a NYSHIP Empire Plan member considering residential mental health treatment, navigating your insurance benefits can feel overwhelming. At Lenape Wellness Center, we simplify this process, providing clear answers and personalized support so you can focus on your recovery.
Call for a fast NYSHIP Benefits Check and quickly understand your coverage options.
Maximizing Your NYSHIP Empire Plan Coverage at Lenape Wellness Center
The New York State Health Insurance Program (NYSHIP) offers comprehensive coverage through the Empire Plan PPO, providing essential support for mental health and substance use treatment. At Lenape Wellness Center, we work closely with your Empire Plan benefits, managed by Carelon Behavioral Health (formerly Beacon Health Options), to ensure you receive the care you need.
Understanding your coverage is crucial when planning for residential mental health treatment. Key aspects of your Empire Plan benefits include:
- Availability: Primarily for NY state employees, retirees, and their dependents.
- Precertification: Residential mental health care requires precertification through Carelon Behavioral Health to ensure medical necessity and maximum benefit coverage. Our team handles this for you.
Ensuring Fair Coverage with Parity Protections
Thanks to federal and state parity laws, your mental health coverage under NYSHIP must match medical coverage in terms of approval processes, coverage limits, and cost-sharing requirements. This protection ensures your mental health care isn’t unfairly limited or more expensive compared to physical health treatments, and we advocate on your behalf to uphold these protections.
How Lenape Wellness Center Fits Your Empire Plan Coverage
Choosing Lenape Wellness Center for your residential treatment means we’ll help you maximize your Empire Plan benefits and manage potential costs, providing comprehensive care in a supportive environment.
Our Residential Treatment (24/7 Care)
Our residential mental health treatment is designed for comprehensive healing and typically involves:
- Length of Stay: Four to six weeks (on average), tailored to your individual needs.
- Daily Clinical Programming: Including individual therapy, Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), EMDR, equine therapy, and recreational activities.
- Ancillary Services: On-site nursing and medication management, with 24-hour professional support to ensure your safety and well-being.
Reducing Your Costs: Single-Case Agreements (SCA)
Although Lenape is considered out-of-network (OON) by default with NYSHIP, we proactively work to negotiate **Single-Case Agreements (SCAs)** to significantly lower your out-of-pocket costs.
- Standard OON Coverage: Typically 80% after a $1,250 deductible, leaving you responsible for the balance.
- With an SCA: Empire Plan often reimburses care as if we’re in-network, dramatically reducing your financial responsibility.
Our administrative team expertly manages the SCA negotiation process on your behalf, simplifying your financial journey so you can focus entirely on your recovery.
“Entrusting yourself or a loved one to others for mental health care can be daunting, yet with Lenape Wellness Center, those fears are alleviated. The facility is aesthetically pleasing, and the true gem lies in its dedicated staff and therapists. Each person there is genuinely committed to helping patients improve.”
Call us or email admissions@lenapewellness.com today to verify your benefits and start your path to recovery.
Your Seamless NYSHIP Authorization Roadmap with Lenape Wellness Center
We want your transition into residential care at Lenape Wellness Center to be as smooth as possible. Our team provides a step-by-step guide to how we secure your NYSHIP Empire Plan authorization, handling the complexities for you.
Eligibility Basics for NYSHIP Empire Plan Coverage
You qualify for NYSHIP Empire Plan coverage if you are:
- An active employee of New York State.
- A retiree or COBRA enrollee.
- A dependent covered under the Empire Plan.
Our Step-by-Step Precertification Process
Lenape Wellness Center streamlines the precertification process with Carelon Behavioral Health:
- Obtain Clinical Documentation: Our clinical team works with your referring therapist or psychiatrist to gather all necessary documentation, including DSM-5 diagnosis, medical necessity summaries, and explanations of prior unsuccessful treatments.
- Contact Carelon Behavioral Health (Beacon): We initiate contact with Carelon Behavioral Health on your behalf (typically by calling 877-7-NYSHIP) to request precertification for residential mental health treatment at Lenape Wellness Center.
- Secure Approval ID: We diligently follow up to secure your Approval ID, typically issued within 3-5 business days, with same-day approvals possible in urgent situations.
- Provide Approval to Lenape Admissions: Once approved, we ensure the Approval ID is processed efficiently, confirming your admission date and preparing for your seamless arrival.
If You’re Denied: Lenape’s Appeals and External Review Support
Should precertification be denied, Lenape Wellness Center provides comprehensive support:
- Internal Appeal Support: We assist you in filing an internal appeal within 180 days, providing necessary clinical documentation and advocacy.
- External Review Guidance: If an internal appeal is unsuccessful, we guide you through escalating to a New York State Department of Financial Services (DFS) external review within four months. External appeals have a high rate of overturning denials (47.2% success in recent years), and we’re here to help maximize your chances.
What You’ll Pay and How Lenape Helps You Lower It
Transparency is essential when it comes to your finances.
Here’s a clear breakdown of potential costs and strategies Lenape Wellness Center employs to reduce them:
Deductibles and Coinsurance (2025 figures):
- Out-of-Network Deductible: $1,250 per enrollee.
- Coinsurance: Empire Plan covers 80% after deductible; you pay the remaining 20% until you reach your annual out-of-pocket maximum.
- Annual Out-of-Pocket Maximum: $3,750 per individual (lower for some income tiers).
Lenape’s Cost-Saving Strategies for You:
- Single-Case Agreements (SCAs): We work proactively to negotiate SCAs to secure in-network-level coverage, reducing your costs dramatically and maximizing your Empire Plan benefits.
- Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA): We can help you understand how to best utilize your pre-tax dollars for deductibles and copays, offering substantial financial relief.
- Interest-Free Payment Plans: Lenape Wellness Center offers flexible, no-interest payment plans for any remaining balances, ensuring treatment is accessible.
To streamline your verification process, our admissions team is ready to assist you by phone.
Information We’ll Gather to Verify Your Benefits:
- NYSHIP ID number
- Group number (usually Group 003)
- Subscriber’s date of birth
- Recent Explanation of Benefits (EOB), if available
Our team handles these calls efficiently, typically lasting about 15 minutes, to provide a clear path toward your admission and peace of mind regarding your coverage.
Remember, deductibles often reset every January 1—applying early ensures you won’t pay twice in quick succession. Our team is here to remove obstacles, manage paperwork, and allow you to focus solely on healing.
Call us or email admissions@lenapewellness.com today to take the first step toward your journey to recovery.
Why NYSHIP Members Choose Lenape Wellness Center
Lenape Wellness Center provides residential mental health treatment in a tranquil, healing environment nestled on a scenic golf course. Our personalized treatment plans integrate evidence-based modalities such as Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), EMDR, equine therapy, and recreational activities, supported by a compassionate, multidisciplinary team dedicated to your recovery.
Transparency is fundamental to our approach—especially concerning billing and insurance navigation. From admission to discharge, our staff supports you every step of the way, providing clear, straightforward communication so there are no surprises regarding costs or coverage. We handle the complexities of NYSHIP benefits so you can focus on healing.
Here’s how one recent family described their experience with us:
“Entrusting yourself or a loved one to others for mental health care can be daunting, yet with Lenape Wellness Center, those fears are alleviated. The facility is aesthetically pleasing, and the true gem lies in its dedicated staff and therapists. Each person there is genuinely committed to helping patients improve.”
Your Simple Admission Checklist at Lenape Wellness Center
Our admission process is clear, supportive, and tailored to make your experience hassle-free. We guide you every step of the way:
- Initial Call: Reach out to discuss your treatment needs. Our compassionate team is ready to listen.
- Benefits Check: Let our team confirm your NYSHIP Empire Plan coverage. We’ll handle the verification process for you and provide a clear picture of your benefits.
- Submit Medical Records: Provide necessary documents for review and approval. We assist in coordinating this information.
- Packing Preparation: We’ll supply a clear packing list to ease your preparations and ensure you have everything you need for a comfortable stay.
- Arrival Day: Our staff welcomes you warmly, guiding you through settling into our peaceful environment, ready to begin your healing journey.
Email admissions@lenapewellness.com to Get Started.
Stories of Hope and Healing at Lenape Wellness Center
Every recovery journey at Lenape Wellness Center is deeply personal and inspiring. Here’s how one of our former residents described their experience:
“After searching through several mental health facilities, we’re so thankful we found Lenape Wellness Center. The care here is compassionate, professional, and truly focused on long-term healing. They supported our family every step of the way.”
We take immense pride in helping clients regain control over their lives and build a foundation for lasting wellness.
Map and Directions to Our Serene Campus
Finding Lenape Wellness Center is simple. Our peaceful, serene campus is located at:
950 Golf Course Rd, Ford City, PA 16226
Easily accessible from major highways, our facility is just minutes away from PA-28, providing clear signage to guide your arrival. We look forward to welcoming you.
Ready to Begin Your Healing Journey with Lenape Wellness Center?
Choosing residential treatment is a courageous step toward wellness. At Lenape Wellness Center, we honor your commitment by providing the comprehensive, compassionate care you deserve, supported by a team that handles the insurance complexities for you. Visit lenapewellness.com/contact-us/ or call now to take your first step toward healing and a brighter future.