The Basics Of Insurance In Mental Health

In this day and age, when someone is on the hunt for a therapist to help with their mental health/emotional issues, they are looking for someone who takes insurance in order to reduce out of pocket expenses. We want to take this opportunity to explain the basics of insurance. We are not experts and we encourage you to contact your insurance representative with questions or concerns.

Commercial vs. Medicare or Medicaid

Most people have insurance through their employer or their spouses employer. Some people have the Affordable Care Act, which is a policy for an individual or family, who do not have coverage thought their employer. This insurance is called commercial insurance. It is not part of Medicare or Medicaid. Each person’s coverage is different depending on their policy. If you would like to know more about what your insurance does and does not cover, please refer to your policy or contact your insurance company with questions.

Insurance Verification

Here at Exhale Behavioral Health, we try to verify our client’s benefits by contacting the insurance company. We can usually verify if the policy is active, if there is a copay, or a deductible that has to be met. Ultimately you, the owner of the policy, is responsible for the details of your policy.

Important Definitions

• Insurance Policy: This is the outline of your insurance details. What is covered, at what cost, and if you need a referral.
• Copay: This is a set amount of money that you owe to the provider when you have an appointment. This can range depending on your policy.
• Deductible: A pre-set amount of money that the policy holder has to meet before they may have a lowered percentage amount to pay the provider. An example could be a deducible of $1000.00. You are charged the allowable rate for the season. Let’s say the amount is $50.00, this adds up until you meet the $1000.00.
• Allowable Rate: A contracted amount of money that the insurance company and provider have agreed as payment, that is lower than the original amount.

Insurance Procedure

When you reach out to make an appointment with one of our clinicians, there are certain steps we take the the process runs smoothly. We do not want clients to have any surprise costs and that they have full understanding of the process. Certain information is gathered, such as name of client, name of policy holder, DOB, address, Policy number, and the number on the back of the card. We will verify your insurance coverage for mental health prior to your appointment.

We make a copy of your insurance card and driver’s license at the time of your appointment. This ensures that we have the correct information.

After your appointment, our system generates a claim for us to submit to your insurance company. The claim has information, such as your name, policy number, clinician’s name, billing code, and a diagnosis code.

How Insurance Companies Reimburse

Insurance companies send Exhale Behavioral Health and the client an Explanation of Benefits (EOB). This breaks down what we charge for the service, what portion the insurance company covers, and the leftover amount that the client is responsible for. Your insurance company also sends you an EOB. When you receive a bill from us, it is for the amount that your insurance did not cover.

We are always available and ready to answer any questions about insurance. But please know that there are some questions we cannot answer, because everyone’s policy is different. We recommend you contact your insurance company to get further clarification.