Mount Pocono Medical

Mount Pocono Medical (Mount Pocono, PA) is a SAMHSA Behavioral Health Treatment Services Locator-registered facility. The facility's programming is outpatient (Outpatient, MAT), not residential. Evaluation of this facility against current clinical standards should encompass ASAM 4e framework alignment, MAT policy, and payer-specific network status.

Care levels at Mount Pocono Medical

Level-of-care documentation: Mount Pocono Medical is an outpatient-focused program (Outpatient, MAT) — patients live at home or in sober living and attend treatment sessions. This level of care is clinically appropriate for mild-to-moderate substance use disorder, or for patients stepping down from residential. Under MHPAEA 2024 medical-necessity criteria disclosure, plan-specific criteria for each of these levels must be available to patients upon request. Mismatch between documented clinical need and offered level of care is a common source of authorization denial.

Insurance and payment

Payment and insurance posture: Mount Pocono Medical accepts Medicaid — which is consequential because facilities that accept Medicaid tend to have the broadest patient populations and the most developed public-sector relationships, though reimbursement structures mean program intensity sometimes differs from commercial-focused centers. Pre-admission Verification of Benefits (VOB) documentation should include: specific plan product and network status, deductible status at time of admission, coinsurance rate applicable, prior authorization status and turnaround, and out-of-pocket accumulation. Under MHPAEA 2024 disclosure rules, plan-specific medical-necessity criteria must be available on request.

Specialty programming

The facility's documented specialty programming includes: Adult women, Adult men. Clinical verification of specialty programming should encompass credentialed staff profile, programming-hour documentation, and specialty-specific medical-necessity documentation for third-party authorization. The MHPAEA 2024 rule addresses specialty-program network adequacy for patients requiring specific clinical capabilities.

Before you call

Operational admission checklist for Mount Pocono Medical: (a) clinical assessment with documented ASAM 4e level-of-care recommendation; (b) insurance benefits verification in writing; (c) MAT policy documentation; (d) accreditation and licensure verification; (e) confirmed prior authorization for specific level of care. Each should be obtained in written form prior to admission. The facility's documented pharmacotherapy offerings suggest MAT is available — confirm the specific medications and prescriber access during the admissions conversation.