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FAQ- Billing

We will file with your insurance and our staff will do our best to estimate your financial responsibility at the time of service. Your insurance company will determine how much your payment is, based on your insurance plan. Your insurance company may changes rates at anytime without notifying us. Please note while we try to get current information from your insurance, your written policy will supercede anything told to us by the representative. We do not have access to your policy information.

Copays and deductible balances are due and payable at the time services are rendered. Acceptable methods of payment include cash, check, debit card, money order and credit card.

Will my insurance cover the cost of therapy?

We will work closely with your insurance; however, some insurances have out of pocket deductibles, coinsurance and copays. We encourage you to contact your insurance first to understand what is and is not covered. If you have questions after speaking with your insurance, please give our Patient Accounts Department a call at 910-347-3010 x244.

What is in-network and out-of-network?

We accept most insurances including those we are out-of-network with, we are in-network with:
- Blue Cross Blue Shield *Please note: Some BCBS plans have their mental health (also called behavioral health) benefits administered by a different company which may be Out of Network*
- MedCost
- Medicare
- TRICARE

Usually out-of-network means you pay more. You may have a deductible of $1000 however that is for in-network, out-of-networks tends to be double the in-network rate.  Some polices do not have an out-of-network option and you may only be seen by in-network providers.

Insurance websites are not always up-to-date. We are only in-network with the insurances listed above. We do not accept Medicaid nor do we accept Self-pay.

What is a deductible and coinsurance?

Some insurances have a deductible amount that you must pay first before insurance starts to pay. It’s similar to a deductible on a car or home insurance plan. Let’s say your deductible is $1000. You will have to pay for each visit up until you reach the $1000, then at that point depending on your insurance plan you may have to pay a coinsurance which is a percentage of the allowed charge.

Deductibles are good for the policy year then it gets reset. For example, Medicare’s policy year is based on a calendar year. Each January 1st the deductible is reset. For 2017 the Medicare deductible was $183. If the deductible doesn’t change for 2018, on January 1, 2018 the deductible gets reset and you have to pay $183 before the coinsurance of 20% kicks in.

Not all insurance policies are based on a calendar year. Please be aware of when your policy year is supposed to reset.

If I have a deductible, what is the purpose using insurance?

Insurances have what is called an “allowable rate”. For example, our office charges $175 for an Evaluation but if you have Blue Cross Blue Shield, their allowable is $153.10 which means you save $21.90.

Each time we file with your insurance you contribute towards your deductible and possibly out of pocket maximum.

What is out of pocket maximum?

Some insurances have an “out of pocket (OOP) maximum” which is the maximum you have to pay before insurance will cover at 100%. Not all insurances have an OOP.

 


 

If you have any billing questions, please call us at 910-347-3010 extension 244.