Pennsylvania Code (Last Updated: April 5, 2016) |
Title 55. PUBLIC WELFARE |
PART VI. Mental Health/Intellectual Disability/Autism Manual |
Subpart C. Administration and Fiscal Management |
Chapter 4305. Liability for Community Mental Health and MentalRetardation Services |
Section 4305.52. Insurance
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(a) If a client is receiving or is expected to receive a community mental health or mental retardation service, or both, that is eligible for insurance, the county administrator or the provider of service shall bill the insurance company for the service prior to billing the liable person. The amount received from the insurance company for services provided over a calendar month shall be deducted from the liability for mental retardation services or the client fee schedule per unit times the number of units delivered that month for mental health services. The liable person shall be billed the remainder up to the liability.
(b) If insurance benefits are not assignable, the provider shall bill the liable person for the total amount of the liability or the amount the insurance company will pay, whichever is greater, and shall assist the person in completing the insurance forms if necessary or requested.