Insurance

The benefits of using health insurance are commonly understood as one focused on financially incentivized. After all, one pays for health insurance, thus, one should use something they pay for. Typically, costs are lower than pay out of pocket for services.

Please be aware that submitting a mental health or physical health invoice for reimbursement from any health insurance company, in any capacity, carries a certain amount of risk to confidentiality, privacy, or to future capacity to obtain employment, military affiliation, health, disability, or life insurance. In some cases, insurance companies may share information with a national medical information data bank. For example, your health insurance record may prevent employment at employers that require high level security clearance such as state employment, federal employment, law enforcement, or military employment. Individuals may also encounter higher premiums or exclusions in their care.

Additionally, insurance companies have the right to require authorization prior to seeking care, audit sessions, deny claims, and limit care in various ways such as limiting approved diagnosis, limiting number of sessions, limiting interventions utilized, and/or limiting session length.

While this information is meant to be transparent, it is not meant to discourage seeking out mental health treatment. Please speak to your provider directly if this is a concern.

There is no way Spoken Balance can adequately explain the in’s and out’s of insurance billing in a way everyone will understand. However, with the thoughts of transparency at hand, let’s briefly dive into the way Spoken Balance utilizes insurance.

• All clients are asked to provide the front and back of their insurance card as well as state issued photo identification for validating you are who you say you are.

• Ideally, Spoken Balance will verify benefits as a courtesy. However, it is exactly that — a courtesy. There is no way to absolutely, with certainty, determine what is covered under an insurance plan until an Explanation of Benefits is processed by an insurance company. Ideally, a courtesy benefits check will happen before you arrive to the office; however, this is not always possible due to various factors such as scheduling and technology challenges.

• An Explanation of Benefits is exactly what it sounds like. It is a detailed account of what Spoken Balance billed to your insurance and what your insurance will, or will not, cover after processing by your insurance. Typically, an Explanation of Benefits will arrive within one month but can take up to six months.

• After a client is seen, Spoken Balance will process the claim. A claim entitles Spoken Balance to get paid by an insurance company. Claims are typically processed daily.

• Deductible: The amount paid out of pocket by the policy holder before an insurance provider will pay any expenses.

• Each insurance plan varies as to whether or not the policy holder must pay down their deductible in full before the policy holder is only responsible for their co-pay or co-insurance.

• Co-Pay: What we are all familiar with as the clients financial responsibility for each session.

• Co-Insurance: A percentage of the contracted rate agreed on between an insurance plan and provider for payment.
  

• For example, if a contracted rate is $100 and the co-insurance is 15%, the client would owe $15.

• Please ask your clinician if you have concerns about the contracted rate your insurance company.

• Contracted Rate: The contracted rate is the agreed upon amount an insurance company will pay for services to a provider.

• This rate is what your provider must bill insurance. It is not negotiable.

• Don’t understand what deductibles, co-pays or premiums mean? You are not alone! Read a bit about them here.

• If you identify within the gender minority community, please be aware insurance paperwork will require sharing legal documents in order to ensure accurate and timely insurance claims.

• Your provider cannot legally waive any patient responsibilities, including co-pay, co-insurance, and deductibles. That is considered insurance fraud.