Many people are confused when it comes to their insurance coverage, which makes sense! There are a lot of terms that may be unfamiliar. Everyone can understand their insurance coverage if they understand some key terms.
If you need assistance in understanding your specific insurance benefits, you should call the number on the back of your insurance card.
KEY INSURANCE TERMS
When a provider is “in-network” it means that they have signed a contract with a particular insurance company. Your provider has to follow the rules set by the insurance company and in turn, you can see the provider with the most cost savings to you.
When a provider is “out-of-network” it means no contract has been signed with the insurance but the provider is recognized as a mental health professional by the insurance company. The insurance will still get to dictate rules, such as whether clients need a diagnosis to use their benefits or how much they will reimburse. Out-of-network providers usually provide clients a Superbill (or receipt detailing services provided and what the client already paid) and the client submits for reimbursement. Typically, clients pay the therapist and are reimbursed directly by their insurance company.
If you don’t know what a deductible is then you aren’t alone. It is one of the most difficult concepts for people to understand if they don’t have experience working in healthcare.
A deductible is a goal you need to reach before your insurance really kicks in. Let’s say your deductible is $200. You have to pay $200 for your medical expenses before your insurance starts helping. After you reach that goal, your insurance will start covering more of the costs.
To understand the different kinds of deductibles, make sure to read the difference between in-network and out-of-network coverage above.
Ways you may hear this term used and what they mean:
- “You have a $2000 in-network deductible.” – The insurance company requires you to pay the contracted rate for sessions to the provider (Kindred) up until you have paid $2000. Kindred submits your claims to the insurance company to let them know how much you have paid already.
- “Your out-of-network deductible is $3000.” – Your out-of-network reimbursement benefits will not kick in until you pay the amount of your deductible toward your care. It is not only therapy that applies toward your deductible.
- “After your deductible is met…” – When you have had enough sessions (or other healthcare services) that you have paid the amount of your deductible and you can now access your benefits.
- Your deductible is waived for mental health.” – This means you can access your mental health benefits BEFORE you meet the deductible.
Deductibles reset yearly.
This is a small fee you pay each time you have a therapy session. It’s like chipping in a bit of money for something. For example, if your copay is $20, you pay that when you see the therapist, and your insurance helps with the rest of the cost.
This is when you and your insurance share the cost of your medical expenses. Let’s say you need a treatment that costs $100. If your coinsurance is 20%, you pay $20 (20% of $100), and your insurance pays the other $80. Some plans have both a copay and coinsurance combined to equal “patient responsibility”.
The amount your insurance company requires you to pay toward the overall cost of your care. May include a copay, coinsurance, deductible, or all of these.
When you use your insurance, you or your doctor send a request to your insurance company for them to help pay for your medical expenses. This request is called a “claim.” When you are seeing an in-network provider, usually the doctor submits the claim or does the asking. If you are seeing an out-of-network provider usually the client submits the claim to insurance.
This is a special price that your insurance and the doctor or hospital have agreed upon. It’s like a discount that your insurance gets for you. So even if the treatment costs $300, the doctor might only charge $200 because of the contracted rate your insurance has.
In this case, the contracted rate is the fee for sessions that the insurance company has agreed to pay Kindred when you have a therapy session. This is also the fee that you will pay for sessions if you need to pay towards a deductible. The contracted rate varies by service (for ex. individual, couples therapy or an intake).
Clients are responsible for reading their insurance policy carefully, being aware of what is or is not covered, and letting Kindred Therapy LLC know if/when their coverage changes. You can call the member services number on the back of your insurance card to find out the details of your coverage.
If you want to use a policy in the Aetna network to access therapy at Kindred, you give Kindred Therapy LLC permission to file claims on your behalf and ascertain information about your coverage, though you are ultimately responsible for using and understanding the limits of your insurance coverage.
We are an IN-NETWORK provider with most Aetna Commercial Plans. Seeing an in-network provider can help you save money even if you have a deductible, because you can access a discounted rate.
To Check Your Aetna Coverage
- Call the member services number on the back of your insurance card to access Coverage and Benefits.
- Say you are calling about your mental health benefits.
- Ask what your coverage is for outpatient psychotherapy.
- If asked for the provider’s tax id:
- Kindred Tax ID: 86-3458509
- If asked for the provider’s NPI:
- Billing Provider NPI2: 1396327318
- Rendering Provider NPI1: 1235658147
- Ask if you have a deductible and if that deductible is waived for mental health.
As an out-of-network provider with most insurances, we have partnered with Mentaya to help clients save money on therapy. Use the courtesy tool below to see if you qualify for out-of-network reimbursement for our services.
I have partnered with Mentaya to help my clients save money on therapy. Check your benefits above to see if you’re eligible for reimbursement, or click this link: https://app.mentaya.com/p/qbgEZDQ16dzenNZvSL5R
If you qualify, Mentaya will handle your out-of-network claims and ensure insurance reimbursement. They charge a 5% processing fee per claim and have helped clients receive thousands of dollars back in reimbursements. To sign up for their service, use this link: https://app.mentaya.com/register?p=qbgEZDQ16dzenNZvSL5R
You are not obligated to use Mentaya’s claim submission service to utilize your out-of-network benefits for therapy at Kindred.