Medical necessity: getting paid for the care you gave
Insurers do not pay for treatment just because it happened. They pay when the chart proves the patient needed that level of care. If the notes are thin, they do not pay, or they take the money back.
Insurers judge that with a standard called ASAM, a checklist for how much care a patient needs. Your notes have to line up with it, at the start and every time the insurer checks again.
The re-checks are where the money goes. An insurer approves the admission, then reviews again every week or two, and can drop the patient to less care or stop covering it. A weak note, and those days do not get paid.
Altair writes the note that proves the patient needed the care, the way each insurer wants to see it, and keeps the days approved through every re-check. The care you give gets paid, and it holds up if the insurer looks again.
Altair is the done-for-you billing service, run by AI, backed by our expert in-house billers. You do not need a billing team of your own. You treat patients. We get you paid.
Common questions
What is ASAM?
ASAM is the standard most insurers use to decide how much care a patient needs, from outpatient up to residential. Your notes have to match it. We write them so they do.
Why do insurers stop covering care partway through?
Insurers re-check during treatment, usually every week or two, and stop covering it if the note does not show the patient still needs that level of care. We send that note on time, every time, so the days stay covered.
Can an insurer take money back for care it already approved?
Yes. An insurer can review care it already paid for and take the money back if the notes do not hold up. We write every claim to match what the insurer wants to see, so when it looks again, it holds up, and the money stays yours.
Sources: the ASAM Criteria for substance use levels of care; insurer medical-necessity and utilization-review policies (2024 to 2026).