Insurance FAQ &
Insurance Research Tool
Unlike other out-of-network providers, we file claims so you don’t have to!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. Are finances a deal-breaker for you? Not sure if you have out-of-network coverage? Want to clarify your benefits before making an appointment? Please consult with your insurance company directly for details on coverage and benefits for out-of-network individual psychotherapy services. We have provided this step-by-step guide to help you empower yourself. Our practice is not currently able to call and verify your benefits for you, but we are happy to file your claims. If finances are an important concern for you, use this Insurance Research Tool for exact questions to ask your insurer. If you would like to work with a Bloom Therapist regardless of coverage, this research is optional. We can simply file the claims and see what they pay. 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.
Insurance Research ToolEveryone’s out of network benefits are different. Simply 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. Because we know this industry can be very confusing to clients, we have developed this insurance research tool to help you make informed decisions. While we do ask that you research and verify your own benefits, our practice is unique in that we file the claims for you! Most out-of-network therapists do not file insurance claims. Our courtesy filing service saves many of our clients time and money.
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 we can help you understand the meaning during our free consultation.
- 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.
- 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).
More Helpful InformationThe most common co-insurance rate due by our insurance clients is 30% of the billed rate (this is $24-30 per session, depending on your therapist’s rate); it can vary, however, between 0-50% of your therapist’s rate depending upon the terms of your plan. 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 deductibles ranging from $250 to $10,000/year, so there is obviously a very broad range of paid benefits. We are a credentialed Out-of-Network Provider for all 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 important to you 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. 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.
Insurance FAQs: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.
- Plans with out-of-network 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 many 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, especially since our rates are so reasonable. 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 before your co-insurance kicks in. 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.
- 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.
- 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.
- Not until the payments start actually being received, and even then, payments are never guaranteed. The best way to determine your benefits is to use our Insurance Research Tool above. We simply do not have a full-time billing assistant. Offering full concierge insurance services would substantially increase the prices we need to charge for therapy. While our electronic filing system allows us to claims easily with most insurers, and saves you the substantial hassle of filing claims yourself, verifying insurance benefits is much less time-consuming when done by the consumer. Therefore, Bloom offers out-of-network insurance processing as a courtesy service only. 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. Certain insurance companies do allow our software to check very basic elements of your coverage quickly and easily, but it is not always easy to decipher or 100% accurate. 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. If finances are an important concern for you, use our Insurance Research Tool for exact questions to ask your insurer.