Referral Process

Self-Pay clients with private insurance- please call your insurance company to determine your out of network reimbursement rate.

All agencies and individuals interested in setting up a private contract should contact the clinic to speak with the CEO or Program Director in order to discuss contract specifics.

Phone: (410) 730-2385
Fax: 1-866-371-5933
Email : program_director@mpbgroupinc.com

The following information is needed to process Medicaid clients:

• Medicaid card
• Custody orders (as applicable for minor children)
• If both parents have custody then both parents must give permission allowing the child to engage in therapeutic services
• All psychiatric/psychological/psychosocial evaluations completed over the last 1-3 years (where available) should be faxed to us by the first appointment.
• Adoption papers for children who have been adopted
• Court orders must be presented for court ordered treatment

These can be faxed or emailed to: FAX: 1-866-371-5933 Email : program_director@mpbgroupinc.com

Uninsured Eligible clients are individuals for whom the cost of medically necessary and appropriate mental health services will be subsidized by the Mental Hygiene Administration (MHA) because of the severity of mental illness and financial need. Depending on the availability of state funding, services may be provided to consumers who meet specific eligibility guidelines.

Uninsured clients need to meet certain criteria in order to be registered as an uninsured eligible client.  Please provide the following documentation in order to be registered as an uninsured eligible client:

• Verification of psychiatric diagnosis (family doctor or psychiatrist)
• Documentation of income (2 most recent pay stubs)
• If unemployed, you will need to provide documentation of termination or documentation of unemployment wages
• Documentation of having applied for Medical Assistance, SSI, or SSDI

If you do not meet the criteria we will fill out an appeal to the Howard County Mental Health Authority to demonstrate an urgent need for services. If the client has not filled out an application for Primary Adult Care (PAC), we will assist in filling out this application.

For the PAC application, you will need to supply the following documentation:

• Proof of citizenship or alien status
• If U.S. citizen – copy of birth certificate
• If non-U.S. citizen – documentation from INS that provides the date the applicant became a permanent resident and the alien registration number
• Proof of identity (e.g., valid MD Driver’s license, MVA ID, or other government photo ID card)
• Documentation of income OR documentation of financial assistance from others
• Documentation of separation or divorce (if applicable)

Please call the clinic if you have questions about Uninsured Eligibility.