Insurance FAQ &
Insurance Reimbursement Calculator (New!)
You may choose any Therapist Name from the drop down bar to estimate your benefits; you don’t need to know who you want to work with yet. If your therapist is missing from the list, they will be added soon. Only the “Session Type” will affect your results; Insurance treats all therapists equally.
Ready to be matched with a therapist?
Because we know this industry can be very confusing to clients, we have developed this webpage to empower you and help you make informed decisions. While we appreciate you taking responsibility to verify your own benefits, we are also happy to help if the calculator above does not work for your entry, and/or if you don’t have time to follow the steps below.
If finances are an important concern for you, please read this entire webpage. Payment is always due in full on the day of service until your insurance payments begin being received to our practice. We will promptly refund any overpayments once those are received, and then you may begin paying your established coinsurance payment on day of service, with our explicit approval. Keep in mind that if your insurance payment does not pay us in a timely manner, for any reason, we will require up-front payment while we wait for reimbursement. This is typically not the case, but happens occasionally.
Not all insurance plans cover out-of-network services, but many do. As a general rule, PPO & POS plans will cover Out-of-Network Providers, and EPO & HMO plans will not. Most insurance cards will state what type of plan it is (PPO, POS, EPO, or HMO) on the front or back of the card. We will not file claims for EPO or HMO plans, unless you have first acquired and provided us with pre-authorization codes granted by your insurer for our services. If you do not have out-of-network coverage, and are having trouble finding an in-network provider in your area that specializes in treating your specific needs or diagnosis, you can call them directly and request pre-approval for out-of-network care with a specific provider on our website. If you would like to try this, contact us for the required NPI number for your desired therapist; your insurer will request that information. If substantial paperwork is required on our end to authorize care, your therapist will charge their hourly rate for that administrative time, and we cannot guarantee coverage or approval. We are unable to accept Medicare or Medicaid at this time. BCBS PPO plans very commonly include good out-of-network psychotherapy coverage. In our experience, those plans will often have low out-of-network deductibles and then cover 50-90% of your therapy cost after that deductible is met. If you have a BCBS PPO plan, clarifying your benefits is likely to help you realize you actually have a lot of choices you can afford when choosing a therapist. Other insurers, such as but not limited to UnitedHealthcare, Cigna, Aetna, and Sana Benefits can sometimes offer very good benefits as well; plans vary widely. Bloom is unique in that we will file those out-of-network claims for you, so it’s just as easy as seeing an in-network provider! Our courtesy filing service saves many of our clients time and money.
Having Problems Using or Trusting the Calculator?
The Third-Party Nirvana Reimbursement Calculator claims an accuracy rate of 94%. Here is how you can confirm these results with your insurance company, should you desire to. You can also follow these steps if the calculator did not work for your specific plan, or you may contact us at [email protected] or 512.710.7645 for assistance.
- Call the Member Services number on the back of your insurance card and ask for clarification on your out-of-network benefits for individual and/or couples therapy, using the guided questions below. Many clients are reimbursed for 50-100% of their session cost depending on their plan benefits.
- Questions to Ask your Insurance Company when you call them:
Make sure you write down the answers! If you don’t know what they mean, you can ask the insurance representative, and/or our billing assistant can help you understand them; simply email [email protected] with any questions.
- Do I have out-of-network coverage for mental health benefits? (also sometimes called behavioral health)
- If the answer is no, you will be responsible for your full session fee, and there is no use in having Bloom Therapy file any claims. If our full fees are not affordable for you, you can email your desired therapist, let them know what rate you could afford, and ask if they would be able to work with you for that sliding scale rate, and/or you can look elsewhere for an in-network provider. While you are on the phone with insurance, you can verify that your plan has in-network mental health coverage.
- If the answer is yes, move to the next question.
- Does the out-of-network coverage for mental health include in-person therapy, teletherapy, or both?
- Sometimes insurance companies will only pay for in-person therapy or only pay for teletherapy.
- Are there any diagnosis exclusions or requirements to qualify for coverage?
- Most plans will cover all situations, including mild to moderate mental health treatment needs, but occasionally some plans require a “severe” diagnosis.
- Write down the representative’s explanation of what diagnoses are and are not covered with your plan.
- Is this coverage subject to a deductible?
- If no, that’s great! Skip to the next question.
- If yes, what is the out-of-network deductible amount?
- Does the deductible reset on January 1st or another date?
- How much of that deductible have I already met for this year?
- What percentage will be covered/reimbursed by insurance (after any required deductible is met)?
- Clarify your co-insurance percentage and insurance percentage. It is usually written as patient responsibility/insurer responsibility, i.e. 30%/70% (should add up to 100%).
- Is the insurance percentage always taken from the provider’s billed rate or is there a maximum allowable amount?
- To date, our rates have always been lower than their maximum allowable amount, so this has not been an issue for our clients, but is still useful to know, should your therapist’s rate increase in the future, or should you see a more expensive therapist in the future, outside of Bloom Therapy. We are trying to be thorough here to eliminate surprises.
- Can you tell me your maximum allowable amount for individual therapy sessions and couples therapy sessions? (Their reimbursement percentage will sometimes be based on this amount, NOT the amount we bill. However, our rates are quite reasonable, so there is generally not much difference, if any.)
- Is there a limited number of sessions covered? How many sessions are covered per week and per year for:
- individual therapy?
- couples therapy?
- family therapy
- group therapy?
- Is pre-authorization required before my session?
- Is pre-authorization required after my first session?
- How much time do I have to successfully submit out-of-network claims after the service date? (We submit promptly with our courtesy claims processing service, but occasionally this is relevant in rare cases that you need to submit claims yourself with a superbill).
With answers to the above questions, you will be empowered and armed with the information you need to help you decide if our services are a good fit for your needs, and/or if you should consider other out-of-network providers as well. If you don’t understand the above information, don’t worry! Simply write down their answers, and as long as you have these answers handy, we can help you understand your financial responsibilities during our complementary initial phone consult. Insurance is a confusing industry! However, you may be able to substantially reduce your health care costs when using insurance.
More Helpful Information
Depending upon your insurance plan, you may need to meet an annual deductible before your insurance starts to contribute towards your session costs. These deductibles will usually reset on January 1st, but sometimes they reset on the date your plan became active, or at the start of the fiscal or academic year. We see a very broad range of out-of-network deductibles, from as low as $250 and up to $10,000/year; likewise, there is a very broad range of paid benefits. Once your deductible is met, your insurance will begin to pay anywhere from 50% to 100% of your session cost, depending on your plan. The most common co-insurance rate due by our insurance clients is 30% of their therapist’s fee; it can vary, however, between 0-50% of the therapist’s rate depending upon the terms of your plan.
We are a credentialed Out-of-Network Provider for most insurance carriers. Out-of-Network is a term that is commonly misunderstood. Many of our clients’ insurance plans have wonderful coverage for out-of-network therapy. Not all insurance plans cover out-of-network services, but many do. As a general rule, PPO & POS plans will cover Out-of-Network Providers, and EPO & HMO plans will not. Most insurance cards will state what type of plan it is (PPO, POS, EPO, or HMO) on the front of the card. If you have Health Insurance coverage that includes Out-of-Network providers, your policy may pay a substantial portion of your session costs; it simply depends upon your healthcare plan.
If finances are an important factor in choosing your therapist, and you have insurance you are hoping to use, do take the time to follow the instructions in the Insurance Research Tool above, and read the detailed Insurance FAQ section below. Knowledge is power! Your wellbeing is worth this effort! Many of our clients are pleasantly surprised with their out-of-network coverage, and this knowledge often substantially increases your ability to choose the therapist you would prefer to work with, as opposed to being limited to in-network options. Some clients co-insurance payments are very similar to what their in-network copay would be with an in-network therapist. Bloom Therapy is very unique in that we are out-of-network, but we file insurance claims for you, so you don’t have to! Almost all out-of-network therapists will instead provide you with superbills and require you to file your own claims. Mistakes are often made when clients submit their own claims, and therefore pay-out is low and/or the process is time-consuming. Our computer software files your claims electronically, efficiently, and correctly, so that you are easily able to maximize your out-of-network benefits and use them for improving your mental and emotional health and wellbeing. Occasionally we hit too many snags in the billing processes with certain insurers, and ask you to file your own claims; this is very rare.
What is an Out-of-Network provider?
- Out of Network providers do not have signed contracts with insurance providers. This allows us to operate independently from bureaucratic practices and do business in a way that is sustainable and fair to our business, our clients, and our employees. We can still accept and process insurance claims, but since we don’t contract with the insurance company, we set our rates based on our company values and service values, rather than being dictated by an insurance company on what we have to charge. Basically, we set our own rates and then your insurance plan dictates how much of that rate your carrier will pay, and how much is patient responsibility.
How does the coverage differ for out-of-network versus in-network services?
- Plans with out-of-network (OON) coverage will generally cover a percentage of your session fee, such as 70%, and you will pay the difference, which in this case would be 30%; this is referred to as your co-insurance payment. If you see an in-network provider (Not Bloom), you are more likely to pay a flat rate co-pay, which is usually somewhere between $25-$40 but varies by plan. For some clients, their co-insurance payment for seeing an out-of-network provider is very similar to what their copay would be for seeing an in-network provider. However, sometimes plans required you to meet a yearly deductible first before they start to help with the costs. A deductible is an amount you have to spend on cumulative out-of-network provider services before your co-insurance kicks in; the cumulative deductible is a combination of all OON provider costs, not just costs from your therapist, but any other OON medical provider you see during that year. Some plans have separate in-network and out-of-network deductibles, some plans combine them, and some plans don’t have them at all. In general, in-network deductibles tend to be lower than out-of-network deductibles. The more expensive your insurance plan, the lower the deductibles tend to be. Out-of-network deductibles can vary broadly, from as low as $250 per year and up to $10,000. Any out-of-network medical services that are filed with your insurance company will all go towards the same deductible; it is not a separate mental health deductible. Many of our clients quickly meet a low out-of-network deductible after just a few sessions, and then enjoy paying just their co-insurance. Just remember that the deductible resets each year, generally on January 1st, but this can vary by plan and employer.
Does my plan cover services by Bloom Therapy?
- As a general rule, PPO and POS plans will cover Out of Network Providers, and HMO plans will not. It is important to understand that sometimes “Coverage” means the charged rate is applied towards an Out of Network deductible that you must meet before your plan benefits start to contribute to actual costs. All Minimum Essential Coverage (MEC) healthcare plans legally must cover mental/behavioral healthcare services in some form, but not every plan has to cover out-of-network services.
How does it work? What will I owe on the day of my first session?
- Every new client is initially accepted as a private pay client and pays the therapist’s full Prompt Private Pay rate on the day of service. This is so we can insure that your therapist is paid in a timely manner for their services until we have a successful claim processed with your insurance company. We will then promptly file an electronic claim for you. Once we receive insurance payment, we will either refund your card or apply your credit to balances owed on future sessions, whichever you prefer. Once we have established that we are receiving successful payments with your insurance company, we usually agree to only charge your coinsurance amount on the day of service and await direct payment for the balance from your insurance. Most Out-of-Network therapists do not offer insurance filing for their clients at all; they will give you a receipt and ask you to do it yourself. It is difficult for clients to file them correctly and they commonly get rejected, or the client just never gets around to it. Bloom offers insurance filing as a courtesy service, as it is line with our mission to increase the ease of access to quality psychotherapy, and we enjoy our billing software that makes it pretty easy on our end. Occasionally we may need to provide clients with a SuperBill to seek benefits from their insurance companies directly; these circumstances are rare and only necessary when the insurance plan is requiring excessive administrative work on our end.
Can you tell me exactly what my insurance will pay?
- Not until the payments start actually being received, and even then, payments are never guaranteed to continue. The most accurate way to predetermine your benefits is to call your insurance company and ask them the questions above. Our Client Care Coordinator can offer some assistance with estimating your benefits, if you are confused or need a bit of assistance. They can be contacted at 512.710.7645 or [email protected]. Please understand that we can never guarantee our best attempts at estimations, and ultimately you are responsible for all billed charges, so that our therapists are guaranteed to get paid for their valuable work. This being said, our electronic filing software allows us to file claims easily with most insurers, and saves you the substantial hassle of filing claims yourself. Bloom offers out-of-network insurance processing as a courtesy service only; if we hit major roadblocks with your insurer, we may ask you to take over the process. Payment is still due in full the day of your first session, and you are ultimately responsible for all charges accrued whether or not your plan covers our services. While we can usually check your basic coverage components quickly and easily, there are sometimes exclusions for various diagnoses or services that are not made apparent until the claim is rejected. In these cases, we can usually make changes to the claims and resubmit them for you; when insurance payments are delayed we will charge your card and then reimburse the same card once we receive the insurance payment. We cannot guarantee any specific reimbursement amounts by insurance, or spend excessive time on billing snags or occasional insurance mistakes. Please consult with your insurance company directly for details on coverage and benefits for your out-of-network individual psychotherapy services using the questions above.
Please note that you are not required to get care out-of-network. You can choose a provider or facility in your plan’s network, which may lower your out-of-pocket costs for therapy. While we do not have any in-network providers at Bloom, you can contact your insurance company to find a therapist who is in your network; this means they have signed a contract with your insurance company, whereas we have not. You can also search for in-network providers on various online therapist directories, such as psychologytoday.com, which allows you to search providers by insurer, although it’s always good to check directly with every therapist before treatment to confirm their network status.
Our website and service agreements clearly state our out-of-network status and your financial responsibilities. Please read all of your paperwork carefully and ask your therapist or our administrative staff if you have any financial questions, as we strive to be extremely ethical in our practice. However, if you believe you’ve been wrongly billed, you may contact our Operational Director and/or the Texas State Behavioral Health Executive Council (https://www.bhec.texas.gov/).
The “No Surprises Act” was signed into law to protect consumers from surprise medical bills, and applies to Emergency Centers and certain In-Network medical Facilities. Bloom Therapy Does not fall into either of these health service categories. You may visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.