Navigating insurance can feel like a constant battle. Insurance companies are constantly changing what insurance name/company they are related to and these names can even vary state-to-state. Each insurance company comes with particular policies that clients and providers must pay attention to in order to optimize coverage and reduce fees as much as possible. There can be so many practice policies, rules, and terminology that it’s hard to know where to start.
We would like to help demystify this process by answering some of our clients’ most frequently asked questions:
Do you take insurance?
Yes! We are proud to say that we are taking Magellan Behavioral Health (Blue Shield of California Mental Health Services Act) and Evernorth (Cigna) insurance. We are currently in the process of getting contracted with Aetna and will be able to see these clients in the near future.
We are also excited to announce that some of our therapists have partnered with Open Path to provide mental health services for those who need additional financial assistance. To find out more information about this service and to see if you qualify, please visit https://openpathcollective.org/?gad_source=1&gclid=CjwKCAjww_iwBhApEiwAuG6ccHhgNkXnDHkXnhFfZ9pBzct0EQjaKNJapB0y8A3Y09d42FCl1Ql_dRoC0mAQAvD_BwE.Â
If you prefer not to use insurance for your sessions, we accept private pay.
How do I know what insurance plan I have?
This is probably the most important question we get from our clients. The reason why this question comes up so often is because some insurances contract their mental health coverage through a different branch/company. For example, Magellan Behavioral Health is the mental health branch of Blue Shield of California.
To find out what insurance plan you have, it is best to call your insurance’s customer service number to find out what plan you have and what is covered. You can find this number on the front or back side of your insurance card. There may also be an option to view your coverage on your insurance’s client portal. You will need to set up/have an online account with your insurance to do this.
When you start receiving services with us, our team calls your insurance for you and checks your coverage. We email you what your coverage will be and if there is any out-of-pocket fees you may have. This way, everyone is clear about what the coverage and fees are even before your first appointment.
What is covered with my insurance?
That depends. Each insurance company has multiple plans with different monthly payments, coverage, out-of-pocket fees, and deductible to best meet your medical and financial needs. Typically, with mental health insurance, outpatient services are covered with a smaller out-of-pocket fee. This means that most insurances cover for mental health services - both in-person and via telehealth. Again, it is important to call your insurance and find out what the coverage and fees are. For more information on how to call your insurance and find out your benefits, read the answer above.
Is there a difference between my medical plan and my mental health/behavioral health plan?
Yes. This can be a little confusing as some medical plans may have a completely different name or company they are using for their mental health plans. For example, Magellan Behavioral Health is the mental health branch of Blue Shield of California and will have different phone numbers to call to find out your benefits. There are also some insurance plans that do not cover mental health services but this is rare. It is best to make sure to verify with your insurance if you have mental health benefits covered with your plan and if it has different contact information.
What is Medicare, Medicaid, Medi-Cal, and IEHP? Do you accept any of these?
We are not accepting IEHP, Medi-Cal, or Medicare at this time, but it is still important to understand what these terms are.Â
Medicare refers to the default federal health insurance for individuals age 65 and older. In some rare cases, individuals who are younger than 65 may have Medicare if they have certain disabilities or conditions.
Medicaid is a federal and state program that helps individuals who need financial assistance covering medical and mental health costs.
Medi-Cal is California’s Medicaid program and helps individuals who need financial assistance covering medical and mental health costs. For more information and to apply, please visit: https://www.healthforcalifornia.com/covered-california/health-insurance-companies/medi-cal.Â
Lastly, IEHP (Inland Empire Health Plan) is the Inland Empire’s regional Medi-Cal program that helps individuals who need financial assistance covering medical and mental health costs. This plan is specific only to the Inland Empire. When you apply for Medi-Cal, you may be automatically enrolled in IEHP if you live in this area.
What are my options if I don’t have insurance?
We understand that insurance isn’t always an affordable options for our clients. It may help to apply for Medi-Cal and see if you are eligible for their reduced cost/free insurance plans. For more information and to apply, please visit: https://www.healthforcalifornia.com/covered-california/health-insurance-companies/medi-cal.
You may also decide that you would like to pay for sessions with your own money. If you prefer this option, we accept self pay.
What is a superbill and do you allow them?
A superbill is a collected statement made from appointments with providers used for insurance reimbursement. Some of our clients are either out-of-network or prefer to submit their claims by themselves for other reasons. In this instance, your provider will collect an itemized list of all services provided (typically every month) and give this list to you to submit to your insurance for reimbursement. This means that the client typically pays for all of the costs of their services up front and receives some payment back from their insurance.
It is important to check with your mental health insurance company how they handle superbills as they may have different procedures or requirements when submitting a superbill. Creating and submitting a superbill also does not necessarily guarantee reimbursement, so you will want to check with your mental health insurance company what they accept before you start services.
What do I do with a superbill?
Our therapists typically create the superbill for you and give this to you to submit to your insurance. Our therapists usually do not submit this claim for you. It is important to check with your mental health insurance company how they handle superbills as they may have different procedures or requirements when submitting a superbill. Creating and submitting a superbill also does not necessarily guarantee reimbursement, so you will want to check with your mental health insurance company what they accept before you decide to take this route and start services.
We hope this has helped answered some of your questions. Please feel free to reach out to us at contact@goldsmithpsychologicalservices.com for any other questions or comments you may have about this topic. You may also contact this email address if you would like to start seeking out additional support through our practice.