insurance basics
how do i ensure that i do not end up with unexpected balances on my account?
To prevent accumulating unforeseen insurance balances, it's crucial to thoroughly understand your insurance benefits. That's why we've assembled the following FAQ for you!
It is your responsibility to verify your benefits and coverage and to inform us of any changes or lapses in private insurance or Medicaid that could lead to an unexpected balance.
Keep your provider informed of any lifestyle changes that might affect your insurance coverage, such as marriage, pregnancy, changes in disability status, turning 65, relocating, or changing jobs.
While we usually have an estimate of your copay before services begin, if your plan includes a deductible or coinsurance, predicting what you might owe can be more complex. We wait to bill you for coinsurance or for amounts that go towards your deductible until we receive your claim back from insurance.
We wait to charge you because we don't know about other medical services you may access that could count toward your deductible until we receive payment for your claim. Understanding your insurance coverage is crucial for budgeting accordingly for your care.
Some errors may not be caught until claims have processed, which means you may have already had multiple sessions with your provider by the time we find an error, as claims processing can take 30-60 days or more.
We understand insurance benefits can be confusing, so keep reading for our most frequently asked questions regarding the use of private insurance:
What mental health services does my insurance plan cover?
Insurance coverage for mental health services can vary widely. It's essential to review your insurance policy or contact your insurance provider directly to understand what services are covered and how.
How do I verify my insurance coverage for mental health services?
You can contact your insurance provider through their website, customer service hotline, or by reviewing your insurance policy documents to verify coverage for mental health services. Be sure to inquire about any copays, deductibles, or preauthorization requirements and how they apply to mental health services.
We recommend consulting your “Summary Plan Description” document in addition to your insurance card to fully understand your benefits, as your card may not specify whether mental health services are covered by an office visit copay or a specialist copay, and/or whether coinsurance or a deductible may apply.
What if my insurance doesn't cover mental health services?
Most private insurance plans cover mental health services to some extent, although a deductible, coinsurance, or copay will likely apply, meaning you will be responsible for some or all of your session fees, even if your plan “covers” mental health care.
If your plan is employer-funded (meaning, your employer pays for your health care expenses directly), you may want to investigate whether your plan covers mental health services.
Do I need preauthorization for mental health services?
Some insurance plans require preauthorization (prior approval) for mental health services. It's crucial to understand your insurance policy's preauthorization requirements to avoid unexpected out-of-pocket expenses.