By Katie Godfrey
Insurance can often be overwhelming and confusing to navigate. Companies don’t always make it easy! At Evoke, we get a lot of questions about how insurance works, so here is a quick guide of frequently asked questions to (hopefully) help make the process more manageable.
What Type of Plan Do I Have?
There are 2 main plans that you can have through your insurance company:
- Deductible: You can expect to pay the “contracted rate.” This is the rate your insurance company has contracted with your provider, based on their services. Once you reach your deductible total, you will be responsible for a coinsurance price that is (usually) less than the deductible.
- Copay: This is a flat fee for each appointment that won’t change unless your insurance policy changes.
The expected costs of your deductible, coinsurance, or copay will depend on your specific plan. We are happy to verify benefits when possible.
Why Do Some Therapists Accept Some Insurance, While Others Don’t?
It all depends on the license that the therapist holds! For example, here at Evoke Mind and Body:
Licensed Clinical Social Workers (LCSWs) and Licensed Marriage and Family Therapists (LMFTs) accept:
- Aetna
- BCBS
- Cigna
- UHC
- Oxford
- Oscar
However, our Licensed Clinical Social Worker Associates (LCSWAs) accept:
- Aetna
- BCBS
This is determined by the insurance company and who they allow to panel with them.
What Happens If I Have a Different Insurance Than the Ones Listed?
If a therapist is out-of-network, you have a couple of options:
- Self-pay with a “superbill.” You first pay the self-pay rate out of pocket, and we will provide you with a superbill. You can then submit the superbill to your insurance company, and they will reimburse you based on the agreed-upon rate. We encourage you to verify benefits in these circumstances to ensure financial feasibility.
- Claim submission. If your plan has out-of-network benefits, you would pay the self-pay rate at the time of your appointment. Then, we’ll submit a claim to your insurance company on your behalf. Finally, they reimburse a set amount directly to you. That set amount will vary and depend on your specific plan, benefits, and insurance company. Whenever possible, we work with you to verify benefits.
How Do I Know My Benefits and Plan Information?
The best way to get that information is by either calling the number on the back of your insurance card, or logging into your insurance portal! If you decide to link up with a therapist here at Evoke, we are also happy to verify your benefits to the best of our ability. Just keep in mind that nothing is final until your insurance company processes the actual claim. That being said, we often have a good idea of your benefits before you begin services with us!
How Often Do You Submit Claims?
Claims are submitted on a weekly basis, and it takes insurance anywhere from a couple of weeks to a couple of months to respond to us. This sometimes causes a delay in knowing exactly what you are responsible for. We make every effort to ensure a smooth process with this and strive to minimize…surprises.
We know how confusing and frustrating the insurance process can be, so we are happy to help navigate it alongside you! Our front desk and billing team are here to answer questions and check your benefits. Please do not hesitate to reach out!
