Pain Management

Admissions – Pain Treatment Program at The Johns Hopkins Hospital

Pain Management | Johns Hopkins Medicine

Due to a high level of interest, there is a waiting list for admission to the Pain Treatment Program (PTP). The Admissions Coordinator will assist you in using the waiting period to complete the following pre-admission requirements:

  1. Contact the Admissions Coordinator to inform us of your interest in the program. You will be asked to review information about our program and to sign and return a copy of the Admissions Agreement
  2. Fax or e-mail a copy of the front and back of your insurance card(s), along with date of birth, address, contact number(s), social security numbers for both the patient and the insurance subscriber This information is essential so that our Business Office can obtain your insurance benefits and determine your estimated financial responsibility. This process usually takes two to three business days. More information about Billing.
  3. The Admissions Coordinator will contact you with the insurance company’s quoted benefits and estimated financial responsibility
  4. Contact your referring physicians to request at that each sends the past three months of your comprehensive clinical records to the admission coordinator (see contact information on page 10) or you can forward the information directly to the admission coordinator. Comprehensive clinical records include: summaries from your current providers, ER visits, and hospital stays.  We will review your records to help determine whether our program is the best option for your treatment.  Please be advised that depending on the requirements of your insurance company, you may need to complete a psychiatric evaluation through your local mental health provider prior to admission. This may be a psychiatrist, psychologist, social worker, or therapist. You will be responsible for requesting your records. Unfortunately, we cannot request them.  Please note that it usually takes approximately three to five business days to review records once received.
  5. You will be eligible for admission when all of these steps have been completed and you have been accepted into the program. We suggest contacting the admissions coordinator weekly for updates.

Admissions

We understand that waiting for treatment and navigating the healthcare system while dealing with chronic pain can be difficult and frustrating.  Unfortunately, due to the small size and unique nature of our program, it is very difficult for us to estimate how long each patient may have to wait before an opening is available.  

Once you have been accepted into the program:

  1. Please call the Admissions Coordinator weekly for status admission updates.
  2. Prepare for your admission and keep us updated on any changes in your schedule that might affect your readiness and insurance changes. We understand that some patients will be traveling long distances and we try to provide as much notice as possible so you are able to make the necessary arrangements. However, your flexibility in scheduling the final admission date is much appreciated and could make the difference in how soon we are able to admit you for treatment. As our ability to offer openings is dependent on other patients discharging, we usually only have one business day’s notice of an opening. The treatment team requests that all patients arrive at 9:30 AM on the day of admission. If you should need hotel accommodations prior to your admission, please contact Johns Hopkins Guest Services at 410-614-5100.

Admissions Agreement

Pain Treatment Program Admissions Packet

What to Bring (and what not to bring) with You

Contact Us

Admissions CoordinatorPain Treatment ProgramJohns Hopkins Department of Psychiatry and Behavioral Science600 North Wolfe Street, Meyer 143

Baltimore, Maryland 21287

Directions

Phone: 410-955-8069

Fax: 410-955-6155

E-mail: psychiatryadmissions@jhmi.edu

Source: https://www.hopkinsmedicine.org/psychiatry/specialty_areas/pain/patient_information/admissions.html

Chronic Pain

Pain Management | Johns Hopkins Medicine

Linkedin Pinterest Pain and Palliative Care Chronic Pain Pain Management Pain Management Procedures

Pain starts in receptor nerve cells found beneath the skin and in organs throughout the body.

When you are sick, injured, or have other type of problem, these receptor cells send messages along nerve pathways to the spinal cord, which then carries the message to the brain.

Pain medicine reduces or blocks these messages before they reach the brain.

Pain can be anything from a slightly bothersome, such as a mild headache, to something excruciating and emergent, such as the chest pain that accompanies a heart attack, or pain of kidney stones. Pain can be acute, meaning new, subacute, lasting for a few weeks or months, and chronic, when it lasts for more than 3 months. 

Chronic pain is one of the most costly health problem in U.S. Increased medical expenses, lost income, lost productivity, compensation payments, and legal charges are some of the economic consequences of chronic pain. Consider the following:

  • Low back pain is one of the most significant health problems. Back pain is a common cause of activity limitation in adults.
  • Cancer pain affects most people with advanced cancer.
  • Arthritis pain affects more than 50 million Americans each year.
  • Headaches affect millions of U.S. adults. Some of the most common types of chronic headaches are migraines, cluster headaches, and tension headaches.
  • Other pain disorders such as the neuralgias and neuropathies that affect nerves throughout the body, pain due to damage to the central nervous system (the brain and spinal cord), as well as pain where no physical cause can be found–psychogenic pain–increase the total number of reported cases.

Back pain is considered chronic if it lasts three months or longer. And in some cases, it’s difficult to pinpoint the exact cause. “If your doctor has exhausted all diagnostic options, it’s time to seek a second opinion,” recommends a back pain rehabilitation specialist.

Two types of pain include the following:

  • Acute pain. This pain may come from inflammation, tissue damage, injury, illness, or recent surgery. It usually lasts less than a week or two. The pain usually ends after the underlying cause is treated or has been resolved.
  • Chronic pain. Pain that persists for months or even years.

What is chronic pain?

Chronic pain is long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. Chronic pain may be “on” and “off” or continuous. It may affect people to the point that they can't work, eat properly, take part in physical activity, or enjoy life.

Chronic pain is a major medical condition that can and should be treated.

What causes chronic pain?

There are many causes of chronic pain. It may have started from an illness or injury, from which you may have long since recovered from, but pain remained. Or there may be an ongoing cause of pain, such as arthritis or cancer. Many people suffer chronic pain in the absence of any past injury or evidence of illness.

What is the “terrible triad?”

When pain becomes such a problem that it interferes with your life's work and normal activities, you may become the victim of a vicious circle. Pain may cause you to become preoccupied with the pain, depressed, and irritable.

Depression and irritability often leads to insomnia and weariness, leading to more irritability, depression, and pain. This state is called the “terrible triad” of suffering, sleeplessness, and sadness.

The urge to stop the pain can make some people drug-dependent, and may drive others to have repeated surgeries, or resort to questionable treatments. The situation can often be as hard on the family as it is on the one suffering with the pain.

How is chronic pain treated?

Chronic pain affects all parts of your life. The most effective treatment includes symptom relief and support.

A multidisciplinary approach to pain management is often required to provide the needed interventions to help manage the pain. Pain management programs are usually done on an outpatient basis.

Many skilled professionals are part of the pain management rehabilitation team, including:

  • Neurologists and neurosurgeons
  • Orthopedists and orthopedic surgeons
  • Anesthesiologists
  • Oncologists
  • Physiatrists
  • Nurses
  • Physical therapists
  • Occupational therapists
  • Psychologists/psychiatrists
  • Social workers
  • Case managers
  • Vocational counselors

Special pain programs are located in many hospitals, rehab facilities, and pain clinics.

The pain management rehab program

A pain management rehab program is designed to meet your needs. The program will depend on the specific type of pain, disease, or condition. Active involvement by you and your family is vital to the success of the program.

The goal of pain management programs is to help you return to the highest level of function and independence possible, while improving the overall quality of life–physically, emotionally and socially. Pain management techniques help reduce your suffering.

To help reach these goals, pain management programs may include:

  • Medical management of chronic pain, including medicine management:
    • Over-the-counter (OTC) medicines may include nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or acetaminophen.
    • Prescription pain medicines, including opioids, may be needed to provide stronger pain relief than aspirin. However, these drugs are reserved for more severe types of pain, as they have some potential for abuse and may have unpleasant and potentially very dangerous side effects.
    • Prescription antidepressants can help some people. These medicines increase the supply of the naturally produced neurotransmitters, serotonin and norepinephrine. Serotonin is an important part of a pain-controlling pathway in the brain.
  • Heat and cold treatments to reduce the stiffness and pain, especially with joint problems such as arthritis

  • Physical and occupational therapy such as massage and whirlpool treatments

  • Exercise to reduce spasticity, joint contractures, joint inflammation, spinal alignment problems, or muscle weakening and shrinking to prevent further problems

  • Local electrical stimulation involving application(s) of brief pulses of electricity to nerve endings under the skin to provide pain relief

  • Injection therapies, such as epidural steroid injection

  • Emotional and psychological support for pain, which may include the following:

    • Psychotherapy and group therapy
    • Stress management
    • Relaxation training
    • Meditation
    • Hypnosis
    • Biofeedback
    • Behavior changes

The philosophy common to all of these varied psychological approaches is the belief that you can do something on your own to control pain. This includes changing your attitudes, the perception of being a victim, feelings, or behaviors associated with pain, or understanding how unconscious forces and past events have contributed to pain.

  • Patient and family education and counseling
  • Alternative medicine and therapy treatments, as appropriate

In addition, treatment may include:

  • Surgery. Surgery may be considered for chronic pain. Surgery can bring release from pain, but may also destroy other sensations as well, or become the source of new pain. Relief is not necessarily permanent, and pain may return. There is a variety of operations to relieve pain. Consult your doctor or more information.
  • Acupuncture. Acupuncture is a 2000-year-old Chinese technique of inserting fine needles under the skin at selected points in the body, and has shown some promise in the treatment of chronic pain. Needles are manipulated by the practitioner to produce pain relief.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-pain

Pain Inpatient Services at Johns Hopkins

Pain Management | Johns Hopkins Medicine

Director: Glenn Treisman, M.D., Ph.D.

The Pain Treatment Program draws on the multidisciplinary expertise of various specialties for coordinated, multi-departmental consultations as deemed appropriate by the treatment team.

The unit where you will be staying is staffed by psychiatrists, resident psychiatrists, nurses, social workers, nurse practitioners and physical therapists who are trained in the evaluation and treatment of chronic pain.

Admission Criteria

  • Chronic pain or other physical complaint (e.g., fatigue, dizziness) for at least six months
  • Medically stable and cleared for admission by referring doctor
  • Agreeable to admission to a secure mental health unit for the purpose of rehabilitation including a signed Admissions Agreement
  • Authorized for admission by health insurance (if applicable) on the day of admission

Summary of Treatment Principles and Methods

Full evaluation and clarification of diagnoses by our interdisciplinary team

  • Comprehensive evaluation of previous treatment, including interdisciplinary consults (if needed)
  • Review of patient records
  • Formulation of individualized treatment and rehabilitation plan

Evaluation of medications for effectiveness, side effects, dependency, and interactions

  • Reduction of pain and discomfort to the greatest degree possible
  • Use of novel pharmacological regimens
  • Tapering from ineffective medications (e.g., opioids, benzodiazepines, muscle relaxants, and psychotropics)

Treatment of the psychological distress that often accompanies intractable pain

  • Treatment of depression and anxiety
  • Treatment of symptoms such as insomnia, fatigue, and cognitive problems
  • Training in communication, interpersonal and coping skills
  • Creation of a daily routine for optimal management of symptoms and functioning

Improving physical function

  • Normalization of body mechanics
  • Increase of activity level and endurance
  • Use of targeted myofascial treatment (if applicable)

What can you expect?

If you adhere to your individualized treatment program during and after hospitalization, then you can expect a reasonable degree of relief from your pain and improvement of your function. Some patients are completely relieved of their pain, and most receive enough benefit in terms of physical functioning and quality of life to have made their efforts worthwhile.

Patients must bring to the program a willingness to work hard and an openness to learn new ways of dealing with pain, and then apply the principles they learn in the program to life at home following hospitalization.

Treatment Approach

Patient-Centered
Our treatment goal is to increase function including the reduction of chronic pain, accompanying emotional and medical complications, and physical deterioration.

This can only be accomplished when a patient forms collaborative relationships with a staff of experts. The program is highly structured and active with an emphasis on promoting independence. It is completely voluntary.

You may refuse to comply with the treatment plan at any time and be discharged from the program.

MedicationsImmediately upon admission, your need for medication will be assessed and all medications that you are taking will be reviewed. Most chronic pain conditions, especially neuropathic pain, can be treated with medications and many options are available.

Unfortunately, medications produce side-effects or can have harmful interactions with other medications – all without relieving pain significantly. We will eliminate the use of ineffective medications, opiates and benzodiazepines, and educate you about pharmacological treatments for pain and related conditions.

Treatment of Depression and Anxiety

Your attending physician will be one of our psychiatrists who specialize in pain management. This does not mean that we suspect your pain is not real. Psychiatric symptoms such as depression and anxiety often accompany chronic pain. It is very important that they are assessed and specific causes treated for full recovery. Our psychiatrists are well versed in eliminating ineffective medications opiates and benzodiazepines. They may also recommend medication to address problems anxiety and depression. These medications are called psychotropics and include medications that target your brain and nervous system. Some examples are anti-depressants paroxetine and fluoxetine, anti-anxiety medications, or medications that help with sleep. Some of these medications also help to treat a person’s pain.

Physical Activity and Behavior Modification
Chronic pain often leads to a loss of physical activity and general deconditioning which contributes to a patient’s disability.

In the first few days after admission, your physical capacity will be assessed and a program of individual and group exercises will begin, as well as individualized physical therapy.

We expect progress during your hospitalization, but this activity program is designed for you to continue on a long-term basis to improve your physical ability and level of function. As part of this process, suggestions will be made as to how to change some behaviors to move the pain experience “ the spotlight” and become more productive.

Transcutaneous Electrical Stimulation (TENS)
Depending on your specific type of pain, you may be treated with an externally applied TENS unit to determine if transcutaneous electrical stimulation will benefit you. TENS is thought to work by “overriding” or blocking the transmission of pain signals from the body to the brain.

Relaxation Training
You will learn techniques to decrease muscle tension or increase blood flow that can reduce certain types of pain.

The same training will help direct attention away from the pain experience through active, focused exercises involving breathing, progressive muscle relaxation, and imagery.

These techniques decrease anxiety and promote a sense of actively taking control of one's problems.

Biofeedback
Biofeedback equipment will be used to enhance you sense of having mastery over your physical and mental function. The experience of patients as well as pain research has taught us that catastrophizing over one’s symptoms can be a particularly distressing aspect of chronic pain.

Group Therapy
Daily group therapy sessions with patients on the unit provide a forum to explore the challenges of coping with chronic pain and its toll on relationships, work, and emotional life.

These meetings provide the opportunity to learn from other patients and decrease the loneliness and isolation that emerge with chronic pain syndromes.

Cognitive-behavioral principles provide the foundation for discussing how patients can objectively analyze their circumstances and sustain their function despite the challenges of illness.

Family Involvement
Social workers and other staff will examine with you the impact of your illness on your family.

Family members will be asked to participate in your care to help increase forms of support and emphasize the benefits of close personal relationships.

Special education sessions are conducted on the weekend and additional meetings may be recommended as part of your treatment.

Length of Time in the Hospital

The length of time in the hospital for each patient depends on many individual factors. The expected length of stay on the Inpatient Unit is two weeks, at which time patients are transferred to the Day Hospital, where the expected length of stay is an additional two weeks.

Stays may be extended if the team feels that patients need more time in treatment before transitioning to the Day Hospital or returning home. We work together with you to formulate your treatment goals and to determine a discharge date. Of course, you may choose not to continue in the program and be discharged at any time.

The principles and practices that we begin with you in the hospital are meant to be continued once you return home. every attempt will be made to communicate with your outpatient care to ensure a coordinated approach for continuing your rehabilitation after discharge.

If additional outpatient services are needed, the PTP will make these referrals with specific recommendations for your overall treatment plan.

Searching for the Sources of Pain

While finding a cure for the cause of your pain would be ideal, the search can lead to even more problems. Repeated consults, diagnostic tests, and therapeutic interventions carry the risk of making pain worse and even causing new types of pain.

They cost time, money and other resources that delay rehabilitation. Every patient's case will be reviewed individually.

Patients must be open to hearing the PTP's formulation and avoiding the trap of having just one more consult, test, or surgery.

Source: https://www.hopkinsmedicine.org/psychiatry/specialty_areas/pain/patient_information/inpatient.html

Better Pain Management in Every Johns Hopkins Hospital

Pain Management | Johns Hopkins Medicine

Clinicians across Johns Hopkins are solving the problem of opioid overprescribing, one patient at a time. They’re recommending nonopioid therapies, warning of opioid side effects, developing treatments that are individually tailored and screening for risk of opioid misuse. Here are just a few examples of the conversations and innovations that are improving patient care.

At All Children’s, A New Resource for Pediatric Pain Patients

Left to right, Jibin Samuel, Allison Fernandez and Richard Elliott.

The 18-year-old came to the chronic pain clinic at Johns Hopkins All Children’s Hospital with complex regional pain syndrome, a chronic condition that caused swelling, discoloration and sensitivity in both her feet. The pain was so intense that the girl had stopped going to school or socializing. 

At the clinic, she received nonnarcotic medications and a nerve block, as well as referrals to a physical therapist and a psychologist, who both helped her learn how to function with the pain. The therapies worked. After months of homeschooling, the girl was able to return to her classroom.

Pain doctors Allison FernandezRichard Elliott and Jibin Samuel launched the chronic pain clinic in March 2017 to help children and teens manage pain from injuries or conditions as diverse as complex regional pain syndrome, amplified pain syndrome, sickle cell disease, cancer, rheumatoid arthritis or chronic headaches. 

“We try to get our patients to be functional,” says Fernandez, medical director of the All Children’s pain management program. “They might still be in some pain, but we want them to return to school and participate in social activities.”

The clinic, which so far operates just a half day per week, is staffed with the three pain doctors, who work closely with a physical therapist, psychologist and occupational therapist. Treatment could include yoga, acupuncture, massage, meditation, individual counseling and family counseling. 

“Patients and families sometimes request opioids,” says Fernandez. “We talk to them and really emphasize the risk of dependence and overdose. In most cases, it’s really not the right treatment for chronic pain, particularly in pediatric patients.”

At Sibley, a Passport to Greater Patient Satisfaction

Dhiraj Jagasia

Inpatients at Sibley Memorial Hospital receive “pain management passports” encouraging them to explore therapies such as meditation, art therapy and low-voltage electrical nerve stimulation. 

When patients try these options, they accumulate stamps in their blue booklets, mimicking the way travelers accumulate passport stamps when they visit new countries.

“Each token represents their commitment to exploring options for their own health and well-being,” says anesthesiologist Dhiraj Jagasia, who helped develop the pain management passport with help from the Sibley Innovation Hub in 2016. “Patients and even staff weren’t familiar with what was available.”

With the help of the pain management passport and other interventions put in place by the multidisciplinary pain team, opioid use decreased, says Jagasia. The booklets present alternative options to opioids, he says, “Although if a clinician determines that a patient needs opioids, we’re not going to withhold anything.”

At the same time, patient satisfaction with pain management, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, went from 38 percent to above 90 percent. Starting in 2018, HCAHPS surveys will ask patients to rate how hospitals communicate about pain, instead of rating how they manage pain. The passports help with that communication, says Jagasia.

“The passports give patients a lot of options,” he says. “They show patients that we’re here to help them and we’ll do whatever it takes to relieve their pain.”

At Suburban, Using Data and Conversation to Screen for Opioid Risk

Barton Leonard

The emergency department at Suburban Hospital screens all patients for risk of opioid misuse or overdoses and determines treatments accordingly.

It was the first in the state, 10 years ago, to start using the Chesapeake Regional Information System for our Patients (CRISP) electronic health information exchange to access a patient’s health and prescribing history across Maryland and Washington, D.C., providers.  

Examining those histories is just one way clinicians assess opioid risk. Another is old-fashioned conversation. “We ask about their prescriptions, we ask if they’re depressed or have thought about suicide,” says Barton Leonard, director of Suburban’s emergency department. “We ask about their medications and whether they have a history of substance abuse.”

Specially trained social workers are available around the clock for more formal risk assessments if necessary, Leonard says.

The results won’t keep patients from getting the medications they need. “We do not withhold proper treatment of pain,” says Leonard, “but we limit opioids and we look for nonnarcotic alternatives. We generally do not give more than a three-day supply.”

Patients at risk of overdose receive prescriptions for naloxone, the lifesaving opioid reversal medication.

Leonard has been an emergency medicine doctor at Suburban for 19 years. In that time, he says, “There’s been an increase in addiction and overdose, but also more focus on it. We now have a better, more mindful approach with the help of shared confidential patient data and honest, open discussions.”

At Howard County, 'Not Just Prescribing a Pill'

Alyson Schwartzbauer

It had taken a week to find the right combination of medications, plus yoga and healing touch therapy. But Alyson Schwartzbauer, a nurse practitioner at Howard County General Hospital, knew she had succeeded in managing the patient’s cancer pain when she overheard the woman arguing with her mother.

“It was good to see someone who had been miserable feel good enough to fight with her family,” says Schwartzbauer, who has been on the hospital’s pain management team since 2016. 

When Schwartzbauer meets a new patient, she starts by talking about their pain management expectations, including how long the therapy will last, and the pros and cons of different treatments. Many tell her they don’t want to take opioids because they worry about side effects and the risk of addiction.

Howard County General Hospital’s pain management program includes referrals for therapies such as yoga and healing touch, said to balance energy fields. “Nonmedication and alternative therapies are often really helpful in managing pain and anxiety,” says Schwartzbauer, who hopes to add music therapy to the hospital wards, inviting a cellist or other musician to play for patients. 

When patients with chronic pain are discharged, she might refer them to local pain clinics for treatments such as physical therapy, acupuncture or radiofrequency ablation, which uses electric currents to ease the pain in nerve tissue. 

“Pain management is not just prescribing a pill,” she says. “It’s treating the underlying condition. It’s adjusting expectations. It’s thinking in new ways.”

At Johns Hopkins Bayview, Palliative Care and the Art of Listening

David Wu

David Wu unfolds the small nylon chair he’s been carrying and lowers himself into it so he’s at eye level with the woman in the hospital bed.

Wu, a palliative care physician at Johns Hopkins Bayview Medical Center, gently takes her hand and listens. She says her pain is minimal, and she glows with pride when talking about her young grandson. 

But the woman is afraid of falling bed, something that happened in a previous care setting. “That sounds it was a bad experience,” says Wu, who promises to do all he can to make sure it won’t happen again. 

Wu, director of the 12-year-old palliative care program at the medical center, works closely with a multidisciplinary team — including social worker Jane Schindler and pharmacist Lynn Frendak — to support patients who are coping with long-term illness, including some who are terminally ill.  

He does ask them to rate their pain, and he prescribes opioids when appropriate — but he spends far more time learning about these men and women. “You’re the boss,” he says to one woman recovering from burns, who doesn’t want opioids because they dull her sharp wit.

“Pain is multidimensional,” Wu says at the end of his day. “In patients with serious illness, it can include physical pain, anxiety, interpersonal concerns and existential fear of dying. We can’t just throw pills at it.”

At The Johns Hopkins Hospital, Learning How Each Person’s Pain Is Different

Srinivasa Raja

Srinivasa Raja studies pain that defies logic — the ache of an amputated limb, the hypersensitivity to touch that remains after the virus that causes shingles has been banished.

“We are trying to understand how the nervous system is altered in these patients,” says Raja, director of pain research in the Division of Pain Medicine in the Department of Anesthesiology and Critical Care Medicine.

Pain in disease states, he says, can be signaled from peripheral nerves damaged by amputation, shingles or other injuries. It can also initiate from a person’s central nervous system after a spinal cord injury or stroke. Factors such as depression and sleeplessness can multiply it. 

Raja, who joined Johns Hopkins in 1981, has devoted his career to understanding how the nervous system sends pain signals and why every person experiences pain differently. To treat pain, he says, “We need to understand what may be happening with that individual patient.”

Over the years, the anesthesiologist and critical care doctor has seen changes in opioid prescribing. For a while, he says, the medications were prescribed liberally for nervous system-based pain from illnesses as disparate as shingles, HIV or diabetes.

Doctors are more cautious now. In 2015, the International Association for the Study of Pain published guidelines that placed opioids as a third line treatment choice, after nonopioid medications and topical treatments.

Raja is now studying how medications that target opioid and cannabinoid receptors might work together to ease neuropathic pain. The research is still in the early stages, though. “The success rate is not high for new drugs,” he says. “There is no simple solution.”

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Source: https://www.hopkinsmedicine.org/news/articles/better-pain-management-in-every-johns-hopkins-hospital

Billing Information About The Pain Treatment Program – Johns Hopkins Hospital

Pain Management | Johns Hopkins Medicine

The Pain Treatment Programs understands that health care can be expensive and that understanding benefits can be difficult. We hope that the following section will help to answer many of the questions we frequently receive about insurance and billing, and will help you make educated decisions about your treatment options.

Admission to our program is a mental health admission through the Johns Hopkins Hospital, Department of Psychiatry and Behavioral Sciences and will be authorized under the Mental/Behavioral Health portion of your insurance, not the Medical portion.

Medicare/Medicaid

The Johns Hopkins Hospital East Baltimore Campus and the Johns Hopkins University Physicians participate with Medicare and Medical Assistance of Maryland.  An Admissions Coordinator will be able to give you information regarding participation with your specific plan.  As a reminder, regulations also require us to bill for Medicare’s deductibles and co-payments, although we participate.

Please note that we are network with Medicare Advantage plans, other than the Johns Hopkins Advantage MD plans, and out-of-state Medical Assistance plans.

Commercial Insurance

The patient is responsible for providing all insurance information to the Psychiatry Admissions Office.  Because benefits vary according to insurance, employer group, and individual plans, the Business Office would have to verify all insurance coverage to determine estimated liability. 

Worker's Compensation Cases

If your medical bills are being handled by a Workers’ Compensation insurer, you will need to schedule a consultation with our Consult Clinic.  The Consult Clinic’s Coordinator can be reached at 410-955-2343.

If you are referred to the inpatient program, please provide the Admissions Coordinator with contact information for your Workers’ Compensation company or case manager.

The Admissions Coordinator will contact a Workers’ Compensation Representative to arrange for reimbursement and contracting.

 This contract must be completed and signed by all Workers’ Compensation representatives as a prerequisite for eligibility.

Prior to your Admission

The first step in the process is to provide the Admissions Coordinator with all of your insurance information.  As a courtesy, our Business Office will then attempt to verify benefits and the Admissions Coordinator will explain your insurance benefits as they apply to our program.

  Please keep in mind, our explanation or quote of your benefits is NOT a guarantee of bill payment.  We are only repeating the benefit information that was provided to us by your insurance company representative.

 If you would to verify the benefits our office has provided, or have any further questions about your benefits, please contact your insurance company directly.

Many insurance policies do not cover 100% of the costs of your treatment.  Our Business Office will estimate your liability, an average length of stay for our program.  You will be asked to provide these payments on the dates of admission to the inpatient and day hospital programs.

 Once the insurance company(s) pays the facility and professional fees, if the balance exceeds the original estimated liability, you will be billed for the remaining amount.

 Regulations also require us to bill for deductibles and co-payments, even for those insurances with which we participate.

Please note that we have a two part billing system in the Department of Psychiatry at Johns Hopkins. Our facility fees and professional (doctor) fees have different billing practices and participation with insurers. For that reason, one of these entities may participate with your insurance, while the other may not.  Coverage for both of these will be verified by our Business Office.

On the Day of Admission

If your insurance policy requires authorization for treatment, the Admissions Coordinator will attempt to obtain this upon your arrival.

PTP admissions are billed under inpatient mental health benefits and are subject to the insurance companies criteria for mental health treatment. In most cases, we cannot obtain authorization prior to your date of admission.

Commercial insurances and medical assistance will require authorization, also called precertification.

Also on the day of admission, you will have an opportunity to meet with a representative of our Business Office, who can answer any further questions you may have about billing, or about your benefits as they have been explained to us by your insurance company. Any required deposits will also be collected at this time.

We accept cash, checks, bank transfers and all major credit cards as methods of payment. Please note that if you are paying cash, we will need to direct you to our cashier’s office to make payment. Credit and debit cards are the preferred method of payment.

Please contact your credit card company or banking facility regarding large payments or balances.

A Note on Authorizations: We are usually successful in obtaining authorization from your insurance company when required. However, sometimes insurance companies deny our initial requests for admission.

If this happens, we usually recommend that you enter the inpatient program for a few days so that our team can further evaluate you and, using additional clinical information, appeal the insurance company’s decision whenever possible.

In these cases, we are usually successful in obtaining authorization through the appeals process. A payment to cover three to four of inpatient fees would be required if you choose to be admitted.

In the rare instances when our appeal is denied, you may then choose either to stay in treatment as a self-pay patient, or to leave the program. In either case, you would be held financially responsible for the treatment you have received. If you made a payment at admission, it will be applied to this cost, but you may need to make additional payments.

 If you are not comfortable taking that financial risk, you may choose to leave the hospital immediately upon learning that the initial authorization request has been denied.

If this unfortunate situation arises, we will gladly continue to work with you and your physician to try to overcome the financial and/or insurance obstacles to treatment in the hopes that you could be admitted at a later date.

Admission to the Day Hospital

On your first day of treatment in the day hospital, any deposits required for this portion of your treatment will be collected.

During Your Stay

Typically, insurance companies authorize a few days of treatment at a time. Our Utilization Review Department will request continuing authorizations throughout your treatment. If at any time your insurance company refuses to authorize further treatment, you will be informed and the team will discuss your options with you.

A Note on Continuing Authorizations: Please be aware that even if we are successful in obtaining authorization, authorization of treatment is NOT a guarantee of bill payment. Your insurance company may authorize treatment, but subsequently make a determination that your benefits were not adequate to cover the bill.

For example, if your plan covers 30 days per calendar year, and you are in the hospital for 35 days, the insurance company may authorize your entire stay, but refuse to pay for the five hospital days that exceeded your plan’s benefit. You are financially responsible for whatever your insurance plan does not cover.

Contact your insurance company with any questions about their policies regarding benefits, authorization, and payment.

After Your Discharge

You and/or your insurer will receive separate bills from the Physicians and from the Hospital. The Johns Hopkins University Clinical Practice Association (CPA) bills for the physicians fees.

The Johns Hopkins Hospital bills for hospital charges.

  Depending upon your insurance, you may not receive a bill at all, but instead receive an “explanation of benefits” which will outline what your insurance was charged and what was paid on your behalf.

Source: https://www.hopkinsmedicine.org/psychiatry/specialty_areas/pain/patient_information/billing.html