Payments & Insurance
Frequently Asked Questions & Answers
A deductible is the amount paid out of pocket by the client before an insurance company will pay any expenses. Deductibles vary in amount depending on the specific insurance plan the client has.
A copay is a fixed amount that you pay for services, dictated by your health insurance plan. Your insurance will pay for the remainder of the service.
Upon scheduling your meet and greet, our billing team will look up your insurance plan based on the information you provide our administrator with. We will email you our verification of benefits findings, but this is always just an estimate. A fully processed insurance claim is the only way to know in definite what you will owe per session. There is a chance the information we provide you with could be different from what you actually owe! We always try our best to provide you with the most accurate estimate.
Most insurance plans do not have a limit on outpatient mental health services per year.
Do I have to utilize my insurance for therapy services?
We cannot tell you to not use your insurance – but this section provides some key advice on when to potentially not utilize your insurance coverage. Because the insurance industry is rapidly changing regarding finances, individual and family plans, and applicable laws, many people are confused by their plan. In fact, there are many times when utilizing your insurance benefits for counseling may offer you no benefit at all. We can work with you on a cash pay rate if utilizing your insurance does not make economical sense for you. We are open to being as flexible as possible!
Scenario #1: High Deductible Insurance Plan
With a high deductible plan, there is a chance you will have to meet your deductible before insurance starts paying for sessions. In this case, you would owe the out of pocket insurance rate that varies by insurance payer. You would only owe this amount if your plan requires you to meet your deductible. For cases such as this, you may choose to go the cash pay route because you likely won’t meet your deductible within the year.
There are many high deductible plans that do not require you to meet your deductible. For example, you may have a $3,000 deductible, but for outpatient mental health services a $30 copay applies (deductible waived). In this case, you would likely want to utilize your insurance benefits!
Scenario #2: An affordable deductible plan with no copay for services
Your health insurance plan may have a lower deductible (anywhere from $100.00 to $2,000.00+ per calendar year) – but no copay for counseling.
Everyone is different, and some people may only want to attend therapy for a few sessions. Depending on your health insurance, you may never meet your deductible with only a few sessions, meaning that you may pay more per session than you would if you elected to do a cash pay rate with your therapist. However, some people still find it beneficial to pay into their deductible, with the hopes that they will meet their deductible that year and have reduced costs for medical care. You have the right to make the decision that works best for you!
Scenario #3: I don’t want my insurance company knowing that I see a therapist
While we will never share your confidential health information without your consent, some people do not want their health information submitted to insurance companies for a variety of reasons. It is your right to not utilize your insurance and work with your therapist on a cash pay rate. The affordable care act made it illegal for health insurance companies to use a “pre-existing condition” against you. However, this may not be the law of the land forever, so you must make a personal decision about your healthcare information and “diagnoses.” We, at Health for Life Counseling Grand Rapids, are working to “stop the stigma” against mental health care and are working to have the healthcare system and society treat the brain and mental health care like they do medicine for all other systems of the body – with respect.
Did you know many insurances will reimburse you for Out of Network services?
Many insurance plans will actually reimburse you (partial or full) for therapy services that you pay out of pocket for. To find out if you qualify for this service, you can call your health insurance company and ask to speak to someone about “out of network” benefits. Most insurance companies require what is called a superbill from your healthcare provider. We are happy to provide you with a monthly superbill in most cases. Just ask!
Questions about Insurance Coverage?
Paige
Office & Billing Administrator
[email protected]
616-200-4433, ext. 2
Ashley Huber
Practice & Billing Manager
[email protected]
616-200-4433, ext. 3
Learn more about the No Surprises Act here.
