All of our mental health providers are in-network providers for most Anthem Blue Cross and Aetna HMO and PPO mental health benefit plans. To ensure a clear and efficient experience, please review the following information regarding what to expect when using your in-network insurance benefit. 

Verification of Benefits & Your Costs:

We will attempt to verify your insurance coverage online before your first appointment.

• If anything is unclear, we will call your insurance company directly to confirm.

• Before your first session, we will inform both you and your clinician of your estimated out-of-pocket costs (co-pays, co-insurance, deductibles).

  • Please note: All amounts are estimates until we receive a processed claim from your insurance company.

Your Responsibility: If you believe the quoted benefits are incorrect, you must contact your insurance company for clarification before your first session. You are ultimately responsible for confirming your coverage and will be responsible for paying for the full cost of services if your insurance company denies a claim.

Payment at Time of Service:

• For our mutual convenience, we require a credit card on file so that payments can be processed automatically (see our Payment Policies page for more information).

• Your card on file will be charged for any estimated or confirmed co-pays, co-insurance, or unmet deductible amounts at the time of service.

  • If estimated amounts differ from actual charges we will first notify you of the difference and you will either be charged or refunded the appropriate amount. 

• A payment receipt is automatically generated and sent to your email on file after every transaction.

Denied Claims, Unexpected Remittance Amounts & Grace Period:

• We strive to ensure your insurance covers services, but denials and unexpected remittance amounts can occur. We will investigate and may ask for your help in advocating for coverage.

• If a denial is upheld, you will be given a 30-day grace period to either pay the contracted rate or the private pay rate, depending on the reason for the denial, or resolve it with your insurance. If the amount due is not paid after 30 days, your card on file will be charged.

• If ongoing services are likely to be denied during this grace period, you will be required to pay either the full contracted rate or the private pay rate, depending on the reason for the denial, at the time of service. If insurance later pays, you will receive prompt reimbursement for any previous payments.

Unexpected Insurance Remittance Amounts:

When we verify your benefits with your insurance company, we are only provided with general information about your coverage. If the online verification portal returns incorrect information, or the call-center representative gives us incorrect information, your claim may process differently than originally quoted. When your claim processes with different information than we received in your estimate, we will investigate to determine if the estimate was incorrect or if the claim processed incorrectly.

• When the estimate is incorrect: The amount listed on your Explanation of Benefits (EOB) is the amount we will charge your card for your services. Our contract with your insurance company compels us to bill the patient responsibility amounts listed on your EOB.   

• When the claim is processed incorrectly: Often the claim can be reprocessed automatically when we contact your insurance company. Occasionally, they will ask for additional information or documentation to determine medical necessity, which we will provide with your consent. 

• When we receive a finalized claim, regardless of whether or not the claim is ultimately corrected, the amount listed on your Explanation of Benefits (EOB) is the amount we will charge your card for your services. Our contract with your insurance company compels us to bill the patient responsibility amounts listed on your EOB.

• In this situation, you have the right to appeal your insurance company’s decision, and have our full support in doing so. Contact Member Services (find the phone number on the back of your insurance card) to begin the appeals process. Member appeals are often successful. 

Payment for Services Denied by Insurance:

If your insurance company denies coverage for services rendered (e.g., due to benefit exhaustion, non-covered services, or medical necessity denials), you will be responsible for the full fee of the service. We will notify you promptly of any denial and your outstanding balance. This balance will be charged to the credit card on file, or you may arrange an alternative payment method by logging into your patient portal within 30 days of notification of the denial.

Appealing Insurance Denials:

We will make an initial effort to resolve any insurance denial in-house by re-submitting claims, providing additional documentation, or engaging in a peer-to-peer review with your insurance company. If these efforts are unsuccessful, and you wish to further appeal the denial, we will provide you with the necessary documentation and support to file an appeal directly with your insurance company. This documentation may include:

• Detailed superbills or statements of services.

• Copies of clinical notes (with your written consent).

• Letters of medical necessity (if applicable).

Please understand that while we will assist you with the required documentation, the appeal process itself, and communication with your insurance company beyond our initial in-house efforts, will become your responsibility. We recommend familiarizing yourself with your insurance plan's appeal procedures.

We are here to help you understand these policies. Please do not hesitate to ask any questions you may have. Thank you for choosing our practice for your mental health needs.

Important Considerations:

• Your Plan: Mental health benefits vary; it is your responsibility to understand your specific plan. Quoted benefits are not a guarantee of payment.

• Changes in Coverage: Notify us immediately if there are any changes to your insurance coverage. Failure to do so may result in you paying the full private pay rate for sessions during a lapse in coverage.

• Authorization: Some plans may require prior authorization for ongoing therapy; we will assist with this.