UNDERSTANDING YOUR INSURANCE BENEFITS

We currently accept many major insurance plans, including:

Aetna

Blue Cross

Cigna

Geisinger

Highmark

PerformCare

Quest

TRICARE

UMR

UnitedHealthcare

UPMC

WellSpan EAP

Insurance companies offer many different plans, and participation may vary depending on your specific plan and provider. We encourage you to contact your insurance company to confirm that your therapist is in network with your specific plan. If you are unsure whether we accept your insurance, please contact our office and we will be happy to help.

You are responsible for ensuring that your insurance coverage is active and that the information we have on file is accurate and up to date.

Please notify our office as soon as possible if your insurance changes, including if you receive a new insurance card, change plans, change employers, add or remove secondary insurance, or experience any other change in coverage.

If services are provided and your insurance is inactive or cannot be billed because we were not provided with current insurance information, you will still be responsible for the cost of those services.

We may verify your insurance eligibility and benefits as a courtesy. However, information provided by an insurance company is not a guarantee of coverage or payment.

The final determination regarding coverage is made by your insurance company when a claim is processed.

We strongly encourage you to contact your insurance company directly if you have questions about your specific behavioral or mental health benefits.

A copay is a set amount that you are responsible for paying for a covered service.

For example, if your insurance plan has a $30 mental health copay, you may be responsible for paying $30 for each covered therapy session while your insurance pays the remaining allowed amount.

Copays vary depending on your insurance plan and the type of service provided.

A deductible is the amount you may be required to pay toward covered healthcare services before your insurance begins paying its portion.

For example, if you have a $1,500 deductible, you may be responsible for the insurance company's allowed cost of your appointments until you have met the applicable deductible.

Meeting your deductible does not always mean that your insurance will pay 100% of future services. You may still have a copay or coinsurance.

Coinsurance is a percentage of the allowed cost of a service that you are responsible for paying.

For example, if your plan has 20% coinsurance and your insurance company's allowed amount for a service is $100, you may be responsible for $20 and your insurance may pay the remaining $80.

Coinsurance often applies after you have met your deductible.

The allowed amount is the amount your insurance company determines can be charged for a covered service under your plan.

If your provider is in network, the amount billed by the provider and the amount allowed by your insurance company may be different. Your copay, deductible, or coinsurance is generally calculated according to your insurance plan and the applicable allowed amount.

Having insurance does not necessarily mean that your appointments will be fully covered.

You may receive a bill because:

• You have a copay.
• You have coinsurance.
• You have not met your deductible.
• Your insurance was inactive on the date of service.
• Your insurance denied the claim.
• The service was not covered under your plan.
• Your insurance information was incorrect or outdated.
• Your insurance company processed the claim differently than originally expected.

If you receive a bill that you do not understand, please contact our office. We are happy to help explain how the claim was processed.

Please notify our office before your next appointment whenever possible.

Provide us with a copy of your new insurance card and any updated subscriber information.

Do not assume that your new plan has the same benefits or that your provider participates with the new plan simply because the name of the insurance company is the same.

If you have primary and secondary insurance, please provide information for both plans.

Insurance companies determine which plan is primary and which is secondary according to coordination-of-benefits rules. It is important that your insurance companies have accurate information about your other coverage.

Failure to update coordination-of-benefits information may cause claims to be delayed or denied.

The best way to understand your benefits is to contact the Member Services number on the back of your insurance card.

You may want to ask:

1. Do I have outpatient mental or behavioral health benefits?
2. Is my provider in network with my specific plan?
3. Do I have a copay for outpatient mental health services?
4. Do I have a deductible?
5. If so, how much of my deductible has been met?
6. Do I have coinsurance after my deductible is met?
7. Is prior authorization required?
8. Are there limits on the number of sessions covered?
9. Are telehealth services covered?
10. Are there any other requirements or exclusions I should know about?

While our office will assist with billing and insurance questions whenever possible, your insurance policy is an agreement between you and your insurance company.

It is ultimately your responsibility to understand your benefits, maintain active coverage, provide us with accurate and current insurance information, and pay any amount determined by your insurance company to be your responsibility.

If your insurance company denies or does not cover services, you will be financially responsible for those services in accordance with our practice policies.

Yes. Depending on your insurance plan, you may be able to receive services from either an in-network or out-of-network provider.

In-Network Provider: A provider who has a contract with your insurance plan. Your insurance typically covers a larger portion of the cost, so your out-of-pocket expense is usually lower.

Out-of-Network Provider: A provider who does not have a contract with your specific insurance plan. Some plans include out-of-network benefits, while others do not. You may have a higher deductible, higher coinsurance, or be responsible for the full cost of services.

Before seeing an out-of-network provider, we recommend calling your insurance company and asking:

• Do I have out-of-network mental health benefits?
• What is my out-of-network deductible?
• What percentage will my plan reimburse?
• Am I responsible for any amount above the insurance company's allowed amount?

Important: Having out-of-network benefits does not guarantee that your insurance will reimburse the full cost of your services.

Copay: A fixed dollar amount you pay for a covered service.

Deductible: The amount you may need to pay toward covered services before your insurance begins paying its portion.

Coinsurance: A percentage of the allowed cost that you are responsible for paying.

Premium: The amount paid to maintain your insurance coverage. Paying your premium does not mean that all healthcare services are provided without additional cost.

Allowed Amount: The amount your insurance company recognizes for a covered service.

In Network: A provider who participates with your insurance plan or network.

Out of Network: A provider who does not participate with your specific insurance plan or network. Your benefits and financial responsibility may be different for out-of-network services.

Explanation of Benefits (EOB): A statement from your insurance company explaining how a claim was processed. An EOB is not a bill. It typically shows the amount billed, the allowed amount, what insurance paid, and what amount may be your responsibility.