Making Residential Mental Health Treatment Accessible
Highlands in Bloom is a licensed residential treatment center in Agoura Hills, California accepting a wide range of PPO insurance plans for residential mental health and autoimmune treatment. We are in-network with Blue Shield of California and Aetna. We also work with clients whose coverage includes Cigna, UMR, Optum, Anthem Blue Cross Blue Shield, Multiplan, and Uprise Health through out-of-network PPO benefits that can meaningfully offset the cost of residential care.
Our admissions team provides complimentary, confidential insurance verification and works directly with your insurance provider to confirm your benefits, explain your coverage, and minimize out-of-pocket costs before any admission decisions are made. Call us at (805) 892-6313 or contact us and we will respond within one business day.
In-Network Insurance Coverage
Highlands in Bloom is currently in-network with Blue Shield of California and Aetna, which may significantly reduce out-of-pocket costs for individuals seeking residential treatment for mental health, trauma, burnout, and chronic stress.
You can review their behavioral health coverage resources:
- Blue Shield of California Mental Health Resources
- Aetna In-Network and Out-of-Network Coverage Overview + Aetna Behavioral Health Provider Manual
These providers typically offer coverage for behavioral health services, including therapy and facility-based treatment, depending on your specific plan.
Insurance Plans We Work With
Blue Shield of California
Highlands in Bloom is in-network with Blue Shield of California for residential mental health treatment. In-network coverage typically produces the lowest out-of-pocket costs and the most straightforward authorization process. Our admissions team works directly with Blue Shield to verify your behavioral health benefits and obtain prior authorization before admission. Blue Shield of California Mental Health Resources.
Aetna
Highlands in Bloom is in-network with Aetna for residential mental health treatment. Aetna PPO plans typically provide coverage for licensed residential treatment centers that meet medical necessity criteria. Our admissions team manages the prior authorization process directly with Aetna and communicates your coverage clearly before any admission decisions are made. Aetna Behavioral Health Coverage Overview.
Cigna
Highlands in Bloom works with clients whose coverage includes Cigna PPO plans through out-of-network benefits. Cigna PPO plans often include meaningful out-of-network coverage for licensed residential mental health treatment when medical necessity is documented and clinical criteria are met. Our admissions team has experience working with Cigna behavioral health departments and can verify your specific out-of-network benefits, explain your deductible and out-of-pocket maximum, and assist with the reimbursement process. If you have Cigna coverage and are considering residential treatment, call us at (805) 892-6313 for a complimentary benefits verification.
UMR
UMR is a third-party administrator for self-funded employer health plans, commonly used by large employers and healthcare organizations. UMR plans vary significantly in their behavioral health benefits depending on the employer’s plan design, but many include out-of-network PPO coverage for licensed residential mental health treatment. Our admissions team is experienced in verifying UMR plan benefits and navigating the authorization process for self-funded employer plans. If your insurance card says UMR, call us at (805) 892-6313 and we will verify your specific plan benefits at no cost or obligation.
Optum
Optum is a behavioral health managed care organization that administers mental health and substance use benefits for a wide range of insurance carriers including UnitedHealthcare, UMR, and many large employer plans. Many Optum-administered plans include out-of-network residential mental health treatment benefits for programs like Highlands in Bloom that meet licensure and accreditation requirements. Our admissions team works with Optum-administered plans regularly and can verify your behavioral health benefits, explain medical necessity criteria, and assist with the authorization and reimbursement process. If your plan is administered by Optum, contact our admissions team at (805) 892-6313.
Anthem Blue Cross Blue Shield
Anthem Blue Cross Blue Shield PPO plans frequently include out-of-network benefits for licensed residential mental health treatment. Our admissions team verifies Anthem behavioral health benefits and communicates your coverage clearly prior to admission so you have a complete and accurate picture of your out-of-pocket costs before making any decisions.
Multiplan
Multiplan is a healthcare cost management network that works with a wide range of insurance carriers. Clients whose plans include Multiplan network access may benefit from reduced out-of-network cost-sharing at Highlands in Bloom. Our admissions team can verify whether your plan includes Multiplan network benefits and explain how this affects your coverage for residential treatment.
Uprise Health and HMC HealthWorks
Uprise Health, formerly HMC HealthWorks, administers behavioral health benefits for a range of employer-sponsored health plans. Our admissions team is familiar with Uprise Health plan structures and can verify your specific benefits for residential mental health treatment.
Other PPO Plans
If your insurance carrier is not listed above, contact our admissions team at (805) 892-6313. We work with most major PPO plans and can verify your out-of-network benefits even if your carrier is not one we work with regularly. Many clients are surprised to learn that their plan provides meaningful residential treatment coverage that significantly offsets their out-of-pocket costs.
Understanding Out-of-Network PPO Benefits for Residential Treatment
Many people with Cigna, UMR, Optum, or other PPO plans assume that out-of-network means uncovered. That is rarely true. Most PPO plans include out-of-network benefits specifically because PPO plan design is built around flexibility of provider choice. Here is how out-of-network residential treatment coverage typically works.
Deductible: Your out-of-network deductible must usually be met before your plan begins reimbursing treatment costs. For many PPO plans, a portion or all of your annual deductible may already be met by the time you seek residential treatment.
Coinsurance: After your deductible is met, your plan typically pays a percentage of the allowed amount for out-of-network care, commonly 50 to 80 percent depending on your specific plan. Our admissions team will explain your specific coinsurance percentage when we verify your benefits.
Out-of-Pocket Maximum: Once your total out-of-pocket spending reaches your plan’s annual maximum, your insurance covers 100 percent of additional covered expenses for the rest of the plan year. For clients who have already had other medical expenses in a given year, the out-of-pocket maximum can make residential treatment more affordable than it initially appears.
Medical Necessity: Insurance coverage for residential mental health treatment requires that the residential level of care be medically necessary based on your clinical presentation. Our clinical team documents medical necessity thoroughly and our admissions team works directly with your insurance provider to support authorization and reimbursement.
The Mental Health Parity and Addiction Equity Act (MHPAEA): Federal law requires that insurance plans offering mental health and substance use disorder benefits provide coverage that is no more restrictive than coverage for medical and surgical conditions. This means your insurer cannot apply stricter limitations to residential mental health treatment than it would apply to comparable medical care.
Out-of-Network PPO Benefits
If your insurance provider is not in-network, you may still qualify for out-of-network PPO reimbursement, which can cover a portion of your treatment costs.
Many individuals are unaware that out-of-network benefits can significantly offset the cost of residential treatment, particularly when working with a team experienced in navigating insurance approvals and reimbursement processes. Our team helps you understand what your plan allows and how to access those benefits effectively.
How We Support You Through the Insurance Process
Navigating insurance coverage for a residential treatment center can be complex. Our admissions team provides hands-on support to simplify the process and advocate on your behalf.
We:
- Verify your insurance benefits and eligibility
- Explain in-network and out-of-network coverage options clearly
- Assist with prior authorization and clinical documentation when required
- Communicate directly with your insurance provider
- Advocate to help maximize reimbursement and reduce out-of-pocket costs
Our role is to remove administrative barriers so you can fully engage in your treatment.
What Insurance Typically Covers
Insurance providers generally approve residential mental health treatment programs when care meets medical necessity criteria. This often includes conditions such as:
- Anxiety and depression
- Trauma and PTSD
- Burnout and chronic stress
- Addiction patterns
- Co-occurring mental health conditions
At Highlands in Bloom, we also support individuals experiencing stress-related physical symptoms, including fatigue, inflammation, and autoimmune-related conditions, within a licensed residential mental health treatment framework. While we do not treat medical conditions directly, addressing underlying stress and trauma is an important part of improving overall functioning.
Additional Payment Options
For individuals who prefer or require alternatives to insurance, we offer:
- Private pay options (cash pay)
- Flexible payment structures
- Guidance on planning for treatment investment
Our goal is to ensure that high-quality residential mental health care remains accessible regardless of your insurance situation.
Verify Your Insurance Benefits
Understanding your insurance coverage is the first step toward accessing care at a residential treatment center in California.
Our team will provide a clear, confidential breakdown of:
- Coverage eligibility
- Estimated out-of-pocket costs
- In-network vs. out-of-network options
- Recommended next steps for admission
A Clear Path to Care
You should not have to choose between receiving clinically appropriate, high-quality residential treatment and financial feasibility. At Highlands in Bloom, we take a transparent, proactive approach to insurance so you can move forward with clarity, confidence, and the support you need.
FAQs
Does Highlands in Bloom accept insurance?
Yes. Highlands in Bloom is a licensed residential treatment center in Agoura Hills, California that works with a wide range of PPO insurance plans. We are currently in-network with Blue Shield of California and Aetna, and we also work with out-of-network PPO benefits from many other major carriers.
Our admissions team verifies your benefits at no cost and provides a clear, confidential breakdown of your coverage before you make any decisions.
Is Highlands in Bloom in-network with Blue Shield of Calfornia or Aetna?
Yes. Highlands in Bloom is currently in-network with both Blue Shield of California and Aetna for residential mental health treatment. Being in-network means your plan’s negotiated rates apply, which typically results in significantly lower out-of-pocket costs compared to out-of-network treatment.
If you have Blue Shield of California or Aetna coverage, contact our admissions team and we will confirm your specific behavioral health benefits and estimated cost-sharing before you arrive.
Can I use out-of-network PPO benefits to cover residential treatment at Highlands in Bloom?
Yes. If your insurance carrier is not in our in-network panel, you may still qualify for out-of-network PPO reimbursement. Many PPO plans cover a meaningful portion of residential mental health treatment even when the facility is out-of-network and many clients are unaware of how significant this benefit can be.
Our team is experienced in navigating out-of-network approvals and reimbursement processes, and we will help you understand exactly what your plan covers before admission.
What conditions does insurance typically cover at a residential treatment center?
Insurance carriers generally approve residential mental health treatment when your clinical presentation meets medical necessity criteria established by your plan. Conditions that frequently qualify include:
Anxiety and depression, trauma and PTSD, severe burnout and chronic stress, addiction patterns, and co-occurring mental health conditions.
At Highlands in Bloom, we also support clients experiencing stress-related physical symptoms including fatigue, inflammation, and autoimmune-related conditions within our licensed residential mental health framework. While we do not treat medical conditions directly, addressing the underlying stress and trauma that contribute to these symptoms is a core part of our clinical programming.
Does insurance cover burnout or stress-related treatment at a residential level?
It can, depending on how your clinical needs are documented. Severe burnout, chronic stress, and their physical manifestations such as fatigue, disrupted sleep, and stress-driven inflammation may meet medical necessity criteria for residential mental health treatment when they significantly impair your ability to function.
Highlands in Bloom specializes in exactly this presentation. Our clinical team creates thorough documentation that accurately represents the severity and complexity of your condition, which is essential for insurance authorization and ongoing approval.
How does Highlands in Bloom help me navigate the insurance process?
Our admissions team provides hands-on support from the very first call. We verify your insurance benefits and eligibility, explain your in-network and out-of-network options in plain language, assist with prior authorization and clinical documentation, and communicate directly with your insurance provider on your behalf.
Our goal is to remove every administrative barrier so you can focus on getting the care you need not on paperwork and hold times.
What does a free insurance verification at Highlands in Bloom include?
When you reach out to Highlands in Bloom, our admissions team will provide a confidential insurance verification at no cost. This includes a review of your coverage eligibility, an estimate of your out-of-pocket costs, a comparison of your in-network versus out-of-network options, and recommended next steps toward admission.
There is no obligation, and you will have a clear financial picture before making any decisions about your care.
Does Highlands in Bloom handle prior authorization for residential treatment?
Yes. Prior authorization, the insurance carrier’s approval before treatment begins is often required for residential mental health programs. Our clinical and admissions teams prepare and submit the required documentation, communicate with your insurer during the review process, and advocate on your behalf throughout.
We also manage ongoing utilization review, which is the continued justification of residential-level care your insurer may request during your stay.
What if I don't have insurance or my plan doesn't cover residential treatment?
We offer private pay (cash pay) options and flexible payment structures for individuals who prefer or require alternatives to insurance. Our team provides transparent guidance on planning for the cost of treatment so you can make an informed decision without financial uncertainty.
High-quality residential mental health care at Highlands in Bloom is designed to be accessible regardless of your insurance situation and our admissions team will work with you to find the right path forward.
Is Highlands in Bloom a licensed treatment center in California?
Yes. Highlands in Bloom is a residential treatment center licensed by the California Department of Health Care Services (DHCS) and holds a California Department of Social Services (CDSS) license (License #195850591). We are located in Agoura Hills, California, and serve clients from across the country.
Our licensure, clinical standards, and insurance relationships are maintained to the same level of rigor that major insurers including Blue Shield of California and Aetna require for in-network partnerships.
Can someone come to Highlands in Bloom from out of state and still use their insurance?
Yes. Highlands in Bloom serves clients from across the United States, and many PPO plans including those issued by out-of-state employers or carriers provide out-of-network benefits that apply to licensed residential treatment centers in California.
Our admissions team regularly assists clients traveling from outside California in understanding and maximizing their out-of-network benefits. If you hold a PPO plan from any major national carrier, contact us and we will verify your benefits and walk you through what to expect.
Can I use my employer-sponsored health insurance to pay for residential mental health treatment?
In most cases, yes. The majority of employer-sponsored health plans including those offered through large national carriers like Aetna, Blue Shield, Cigna, Anthem Blue Cross Blue Shield, UMR, UnitedHealthcare and more include behavioral health benefits that can apply to residential mental health treatment when medical necessity criteria are met.
Highlands in Bloom is in-network with Blue Shield of California and Aetna, and we work with out-of-network PPO benefits from most major group health plans. Whether your employer provides coverage through a large national insurer or a self-funded plan administered by a third party, our admissions team will verify your specific behavioral health benefits before you make any decisions.
Many working professionals are surprised to learn how much of their residential treatment is covered by the plan they already have through work. We encourage you to call us so we can give you a clear, no-obligation breakdown of what your employer plan actually includes.
Does my EAP (Employee Assistance Program) cover residential mental health treatment?
EAPs are typically designed to cover short-term counseling usually 3 to 8 outpatient sessions rather than residential or inpatient levels of care. For that reason, an EAP alone is unlikely to cover a full residential treatment program.
However, your EAP is often a separate benefit that runs alongside your primary health insurance, not instead of it. This means you may be able to use your EAP for initial sessions or a referral, while your primary employer-sponsored health plan covers the residential treatment itself.
Our admissions team can help you understand how your EAP and primary insurance work together, and identify the most effective path to coverage for your specific situation. Many professionals find they have more coverage available than they initially realized.
Will my employer know if I use my health insurance for residential mental health treatment?
Your employer does not have access to your individual claims data or your diagnosis. Under HIPAA, your protected health information including the fact that you sought residential mental health treatment, your diagnosis, and the details of your care cannot be shared with your employer by your insurance carrier or by Highlands in Bloom without your written authorization.
If your employer is self-insured (meaning they fund their own health plan and use an insurance carrier only for administration), a firewall is legally required between the benefits administrator and any HR personnel who make employment decisions. This is a standard compliance requirement under HIPAA.
Where confidentiality requires more care is with your Explanation of Benefits (EOB) a document insurers send to the policyholder summarizing claims. If your insurance policy is in your name, your EOB comes to you. If you are on a spouse or domestic partner’s plan, they may receive it. If this is a concern, our admissions team can walk you through options to manage this proactively before treatment begins.
Highlands in Bloom takes the privacy of our clients seriously, and we are happy to address any confidentiality questions directly before you make any decisions about care.
Can I take FMLA leave for residential mental health treatment and protect my job?
Yes. Residential mental health treatment is explicitly covered under the Family and Medical Leave Act (FMLA). FMLA entitles eligible employees at covered employers to up to 12 weeks of unpaid, job-protected leave per year for a serious health condition, which includes mental health conditions requiring inpatient or residential care.
To be eligible, you generally need to have worked for your employer for at least 12 months, have logged at least 1,250 hours in the past year, and work at a location where the employer has 50 or more employees within 75 miles. Your employer is required to maintain your health benefits during the leave period and restore you to the same or an equivalent position when you return.
The process typically involves notifying HR of a need for medical leave (you are not required to disclose that the condition is mental health-related) and obtaining certification from a licensed healthcare provider. Our clinical team can provide the necessary medical documentation to support your FMLA application.
Some states, including California, offer additional protections through their own family and medical leave laws that may apply even if federal FMLA does not. We recommend consulting with an employment attorney or your HR department for guidance specific to your situation, and our admissions team is available to answer questions about how this process has worked for other clients.
My insurance denied coverage for residential mental health treatment. What can I do?
A denial is not the final word and it is often not the right one. The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that requires insurance plans to cover mental health and substance use disorder treatment at the same level they cover medical and surgical care. Denials that apply stricter criteria to residential mental health care than to comparable medical treatment may violate this law.
When a claim is denied, you have the right to a formal internal appeal, and in many cases a subsequent external appeal reviewed by an independent organization outside your insurance company. Our admissions team and clinical staff are experienced in supporting clients through this process including preparing clinical documentation that addresses the specific grounds for denial and demonstrates medical necessity clearly and compellingly.
Denials based on “lack of medical necessity” are among the most common and the most successfully overturned. If you have received a denial, contact our admissions team before giving up on coverage. We will review the denial with you and advise on the most practical next steps.
Does insurance cover residential mental health treatment, or only outpatient therapy?
Insurance covers more than outpatient therapy. The behavioral health system operates across a continuum of care from outpatient sessions, to intensive outpatient programs (IOP), to partial hospitalization programs (PHP), to residential treatment, to inpatient psychiatric hospitalization. Most PPO plans include coverage at every level of this continuum when the level of care matches your clinical needs.
Residential treatment is appropriate and insurable when your condition cannot be safely or effectively addressed in a less intensive outpatient setting. Factors that support residential level of care include the severity of symptoms, functional impairment, lack of a stable or supportive home environment, the need for 24-hour clinical structure, or a history of not improving with outpatient treatment alone.
At Highlands in Bloom, our clinical team conducts a thorough assessment and prepares documentation that accurately reflects the medical necessity of residential-level care. This is a critical part of securing insurance authorization and ensuring your treatment investment is supported by your plan.
Does Highlands in Bloom accept Cigna?
Yes. Highlands in Bloom works with clients who have Cigna PPO plans through out-of-network behavioral health benefits. Cigna PPO plans typically include out-of-network coverage for licensed residential mental health treatment when medical necessity criteria are met. Our admissions team verifies Cigna benefits at no cost and can explain your specific coverage before you make any decisions. Call (805) 892-6313 to verify your Cigna benefits.
Does Highlands in Bloom accept UMR?
Yes. Highlands in Bloom works with clients whose coverage is administered by UMR (out-of-network), a third-party administrator for self-funded employer health plans. UMR plan benefits vary by employer plan design and our admissions team will verify your specific plan benefits at no cost or obligation. Call (805) 892-6313 to verify your UMR benefits.
Does Highlands in Bloom accept Optum?
Yes. Highlands in Bloom works with clients whose behavioral health benefits are administered by Optum. Optum administers benefits for UnitedHealthcare, UMR, and many large employer plans, and many Optum-administered plans include out-of-network residential mental health treatment benefits. Call (805) 892-6313 to verify your Optum benefits.
What does out-of-network mean for my coverage?
Out-of-network means that Highlands in Bloom does not have a contracted rate with your insurance carrier, but your PPO plan still provides coverage for our services through your out-of-network benefits. After your out-of-network deductible is met, your plan typically reimburses a percentage of covered charges. Our admissions team will explain exactly what this means for your specific plan before you make any decisions.
How do I find out if my insurance covers residential treatment at Highlands in Bloom?
Call our admissions team at (805) 892-6313 or submit a verification request through our contact page. We conduct complimentary insurance verification within one business day and provide a clear explanation of your benefits, estimated out-of-pocket costs, and recommended next steps.
Does insurance cover residential treatment for autoimmune conditions?
Residential treatment at Highlands in Bloom is billed as residential mental health treatment, which is a covered benefit under most PPO plans when medical necessity is documented. The autoimmune conditions we address are treated within a licensed residential mental health framework. Our admissions team can explain how your specific plan addresses residential mental health treatment and what documentation supports authorization.
What if my insurance denies coverage?
Insurance denials for residential mental health treatment are not uncommon and are frequently overturned on appeal. Our admissions team assists with the appeals process and can provide clinical documentation supporting medical necessity. Federal parity law also requires that insurers apply the same standards to mental health treatment as to comparable medical care, which is a basis for appeal if your plan’s behavioral health coverage appears more restrictive than its medical coverage.
How much does residential treatment at Highlands in Bloom cost out of pocket?
Out-of-pocket costs depend entirely on your specific insurance plan, your deductible and out-of-pocket maximum, and how much of those amounts have already been met in the current plan year. Our admissions team provides a clear, honest estimate of your expected out-of-pocket costs during the complimentary insurance verification process so you have complete information before making any decisions. Call (805) 892-6313 to get a clear picture of your costs.