Insurance: Claims, Copays, & Deductibles 101

Hi, I'm Sarah from Rose Wellness, and today I want to talk to you a little bit about how the whole using health insurance policy with therapy services at our practice works. First and foremost, I want to let you know that if you've ever felt a little confused or intimidated by navigating health insurance within the therapy world, I completely understand. I've been there myself, and I hope this video will help clear things up and make things less confusing. Know that if you have any questions, we always love hearing from you, so feel free to reach out to us at admin@rosewellnesscounseling.org, and we're more than happy to answer your questions because we want to make the process as easy as possible and just support you however we can on the billing side of things. So let's start at the beginning. When you start at our practice, what we will do is before you even meet with your therapist, we're gonna send you a little script so that you can call your health insurance company and ask them some specific things, and they can let you know what therapy sessions will cost ahead of time. We have found that this is the best way to get the most accurate information so that there's no miscommunication about the cost of sessions. From there, you'll meet with your therapist for your first session, and we'll begin the process of working with your health insurance company. We will need permission to talk to them about your treatment, and that's something that is part of your intake paperwork that we talk more about and you sign a form about after reviewing. And that allows us to communicate with them to make sure that the treatment we're giving you is, quote, a medical necessity. Usually for the first session, it can take a little bit of time to hear back from insurance about the initial cost just because they're reviewing the initial diagnosis and treatment plan. And that kind of thing. Once we hear back from insurance about the initial cost for the first session, that's when we sort of can start the official copay billing process. How that works depends on the kind of insurance plan you have. For everyone, we're gonna keep a card on file so that you don't have to go in and manually pay, but we can sort of do that automatically on our side. If you have an insurance plan that doesn't have a deductible, usually after your first session we'll get an idea of what your general copay will be for all of your sessions for that year if you stay on that plan for the whole year. For instance, usually it's between like $5 and $50. So usually we'll hear back from insurance and they'll say, hey, this person has a $15 copay. From there, we'll just estimate that to be your copay for your sessions moving forward, and we will just automatically charge your card those $15 or whatever it is within 24 hours of each session until the plan changes for the new year or you get a new plan. Whenever that happens, we send you a little email to be like, "Hey, we heard from insurance and they let us know that this is your copay." And of course, if anything changes or if any hiccups come up, we will obviously let you know. If you're someone who has a deductible, we go about the process a little bit differently so that we don't end up overcharging you. What that looks like is if you have a deductible, basically for those of you who don't know, what that means is that your plan is like, hey, you have to pay this amount, like sort of somewhat full price for services, and then after that we're gonna cover X amount for services. So usually for folks who have a deductible, their first session could be anywhere between $96 and $122, while follow-up sessions are usually between $96 and $110-ish. Again, there can be some wiggle room there just depending on your plan. And if that is the case, we're not going to just estimate that your sessions are going to cost $100+ until the end of time because we don't want to overcharge you. So what we'll do is we'll send you an email and be like, hey, just as a heads up, it looks like you have a deductible, um, and this is what your initial session costs. And from there, what we will do is we will just wait to hear back about each individual claim, um, to see when we charge your card. Usually the time that it takes to hear back about each claim is within a couple of weeks or a week or two once the first session has come through. It can be more than that though, just depending on on insurance and how that works. So this means that you might be charged a copay for a session a couple weeks later or even longer later than the session took place, but it's not that we're trying to delay the process. It's just that we don't want to overcharge you or anything like that. Now, once your deductible is met, then the copay usually becomes more predictable. Like, the copay can change from $100 and so to like $20 or even $5, or for some folks, sessions are just fully covered. Once that happens, we'll let you know, and then at that point, we'll just estimate that that will be your copay for the rest of the year and charge your card within 24 hours of the session. I hope that clears things up and answers questions. Once again, we just want to make this process as easy as possible. Know that if any hiccups come up, we're gonna do everything we can to navigate that. If we need your help, we'll reach out to you. And as I said before, there's no silly question or anything, so you're more than welcome to reach out to us. Thanks!