Insurance

Understanding Your insurance coverage

In-Network Providers: We have agreed upon pricing with your insurance company, which typically reduces your personal cost. Using in-network services generally smoothens the claims process and decreases your out-of-pocket expenses.
Out-of-Network Providers: We do not have contractual rates with your insurance company. If you choose an out-of-network provider, you are likely to face higher costs. We will provide a superbill for you to submit to your insurance for potential reimbursement.

Coverage Limitations: Familiarize yourself with what your insurance plan covers, such as the type of therapies and number of sessions per year.
Preauthorization: Some plans require preauthorization, which means you need to obtain approval from your insurance provider before receiving services to ensure the session is covered.
Referrals: Check if your plan requires a referral from a primary care provider (PCP) before attending therapy, which is common if you have an HMO plan.

Deductible: The amount you need to pay before your insurance starts paying. Know your deductible balance.
Copay: A fixed amount you pay for a therapy session, with the remainder covered by insurance.
Coinsurance: Your share of the cost of a session, usually a percentage, after your deductible is met.
Out-of-Pocket Maximum: The maximum amount you pay in a year. After reaching this limit, insurance covers 100% of further costs.

Deductible: This is the amount you pay out-of-pocket before your insurance begins to cover costs. For example, if your deductible is $500, you need to pay the first $500 of your therapy sessions out-of-pocket each year.
Copay: This is a fixed amount you pay for each therapy session, and the insurance covers the rest. For example, a $20 copay means you pay $20 at each visit regardless of the session’s total cost.
Coinsurance: This is the percentage of the cost of each therapy session you pay after meeting your deductible. For example, if your coinsurance is 30%, and the session costs $100, you pay $30.
Out-of-Pocket Maximum: This is the maximum amount you will spend in a year. Once you reach this limit through deductibles, copays, and coinsurance, your insurance will cover 100% of additional covered expenses.

Confirm Insurance Details: Before starting therapy, verify whether Customized Behavioral Healthcare is in-network and understand the details of your mental health benefits, including preauthorization requirements and session limits.
Preauthorization and Documentation: Obtain necessary preauthorizations if required. This can typically be done over the phone or online through your insurance provider’s website. Keep a record of all communications with your insurance for your records.
Session Attendance: Consistently attend scheduled sessions. Cancel at least 24 hours in advance to avoid a cancellation fee of $75. Late cancellations and missed appointments are generally not covered by insurance.
Managing Payments: After each session, we will submit a claim to your insurance detailing the services provided. You will receive an Explanation of Benefits (EOB) from your insurance detailing their coverage. This document is crucial for understanding what portion of the bill you are responsible for. Any remaining balance after insurance processing will be billed to you, and payment can be made using the method on file.

Claims Submission for Out-of-Network Care: If you opt for out-of-network services, you’ll need to submit a superbill to your insurance company. We provide detailed superbills that you can directly submit to ensure you are reimbursed according to your plan’s out-of-network benefits.
Coordination of Benefits: If you have multiple insurance plans, determine which one is the primary and which is the secondary. The primary insurance pays first, and the secondary can cover the remaining amount up to the covered limit.
Therapist Qualifications and Referrals: Make sure that our qualifications comply with your insurance’s standards. If your insurance requires a referral, please ensure you have this before your first visit to prevent any issues with claim rejections.