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Fees and Commercial Insurance Frequently Asked Questions




Is there a fee for services provided by the New Jersey Children’s System of Care/PerformCare?

We do not charge you for calling us. PerformCare is the contracted system administrator for the New Jersey Children’s System of Care (CSOC), and helps families by making service recommendations and linkages that will best meet the needs of your child and family. Families will be asked to provide insurance information as part of this process.



What kind of services can I access through the New Jersey Children’s System of Care?

Youth can receive needs assessments, Care Management, Mobile Response services, and various treatment programs based on a decision by PerformCare that considers the youth’s needs and the most appropriate type of service. That decision may be made after a clinician speaks with you over the phone or after your child has received a face-to-face assessment.



Are services that I am referred to by PerformCare free?

Services recommended and authorized by PerformCare are paid by a variety of sources, such as public funds that include Medicaid and NJ FamilyCare, and commercial insurance or self-pay. Although families may not be charged for certain services, they are not free and families will be asked to provide insurance information as part of their contact with PerformCare. All families referred for services who are not already Medicaid or NJ FamilyCare eligible will be required to complete an eligibility application.



My family or child does not have insurance or Medicaid. How can I apply for Medicaid?

If you have questions about Medicaid or NJ FamilyCare, you can get information online at njhelps.org. To request applications for Medicaid or NJ FamilyCare you may contact your local County Welfare Agency, or you can complete an application online at www.njfamilycare.org/apply.aspx or oneapp.dhs.state.nj.us

If your child is assessed as requiring Mobile Response and Stabilization Services or Care Management, the Medicaid or NJ FamilyCare application can be completed when you meet with them. The Mobile Response or Care Management staff will have the application available and will help you complete it.



Why am I being asked for my insurance information?

It is necessary to collect all information about health benefit resources available to the family in order to coordinate all available services across funding sources that best suit the needs of the youth.

Your insurance information is recorded in your child’s file so that our service providers have all the information to identify services and treatment options for which your child is eligible, and to determine who will be responsible for funding those services. We strongly encourage families to use their commercial health insurance, because there may be more behavioral health treatment options available through the commercial insurance plan.



What will you do with my insurance information?

Your insurance information will be stored in your child’s electronic record that is maintained by PerformCare for identifying available health coverage and resources. Your insurance information is transmitted to NJ Medicaid where it is centralized and used for coordination of benefits if your child is or becomes eligible for Medicaid or NJ FamilyCare.



What does "coordination of benefits" mean?

Coordination of benefits identifies the primary payer for each service. Some services may be covered primarily by your commercial insurance carrier, while others are covered if you are found eligible for Medicaid, NJ FamilyCare, or other public funding. New Jersey regulations require commercial insurance to be billed first if a youth is covered by both Medicaid and commercial insurance.



Can I still get services if I don't give you or I don't have my insurance information?

We can refer you to access services, but you will have to give your insurance information for actual delivery and continuation of any services provided with public funds. If the youth does not have Medicaid or NJ FamilyCare, you will be required to complete applications for Medicaid, NJ FamilyCare, and/or other state benefits as a condition for continuing to receive services.

These applications will require you to provide income and insurance information. If you are referred to Mobile Response Stabilization Services or Care Management Services, the service providers will help you complete the applications. Any delay in completing the application could delay access to services provided through the New Jersey Children's System of Care.



Why do I have to complete an application for Medicaid or NJ FamilyCare when I have commercial insurance?

Your family may be found to qualify for Medicaid or NJ FamilyCare as secondary insurance or your child may be approved for other public funds that will cover the cost of certain health care services accessed through CSOC to supplement your commercial insurance benefits.



Why do I have to apply for Medicaid or NJ FamilyCare to receive your services?

Medicaid and NJ FamilyCare are the primary funding sources for most of our services that are traditionally not covered by commercial insurance. Qualifying for Medicaid or NJ FamilyCare provides access to and coverage for these services. If your family does not qualify for Medicaid, your child may qualify for other public funds to cover the cost of certain behavioral health services.



Will my insurance be billed?

PerformCare does not bill for the services we refer you to. Some service providers we refer you to may bill your insurance company if the service is covered, or you may seek reimbursement from your insurance company as part of the coordination of benefits.



Do you accept commercial insurance?

PerformCare is an information and referral resource for families. We are responsible for authorizing services covered by Medicaid, NJ FamilyCare, or other public funds, but we do not actually provide billable services. The service providers who actually provide the service may bill your insurance company if the services are covered by your health benefit plan.



How do I find an outpatient counseling therapy provider when I have commercial insurance?

You can contact the phone number on the back of your insurance card to find a provider and determine your behavioral health coverage.



How can I get outpatient counseling or therapy services for my child when I don't have commercial insurance and I don't qualify for Medicaid or NJ FamilyCare?

Many community mental health centers provide services on a sliding fee scale.