Verification
Before your appointment.We check your active coverage to verify that your plan is active and in good standing.
Important Note: While we verify that your coverage is in an active status, it is ultimately your responsibility to determine if a specific provider is “in network” with your plan and you are aware of your insurance policy benefits.
The Appointment & Coding
Day of your session.After your visit, your provider documents the session and assigns standardized CPT (Current Procedural Terminology) codes. These codes specify exactly what services were provided, such as a psychiatric evaluation or routine follow up therapy session.
Claim Submission
Within a few days.Our billing team securely compiles your session codes and clinical diagnosis into a formal claim and submits it directly to your insurance company.
Adjudication
Typically 14 to 45 days.Your insurance company receives and reviews the claim against your specific policy benefits. They decide the “allowed amount” for the service, how much they will pay us, and how much is your financial responsibility based on your deductible or copays.
Explanation of Benefits (EOB)
Mailed or emailed to you by your insurance company.Your insurance generates an EOB and sends it to you. This document details how they processed the claim. An EOB is not a bill. It is simply a summary showing what was billed, what they paid, and what your estimated responsibility is.
Final Billing & Payment
Once the claim is closed.Your insurance company sends us their portion of the payment along with a final processing report. If the report indicates you have a remaining patient balance, we will notify you by providing an electronic statement in your patient portal.Please review our Financial Responsibility & Payment Policy for for details.
Important Note: If a manual payment is not made within 30 days of the statement being provided, All outstanding balances will be automatically processed securely using the payment method on file the first of the next calendar month.
Common Insurance Questions
Why does it take so long to get a final bill?
Why does it take so long to get a final bill?
Because we must wait for the “Adjudication” step to finish. Insurance companies have up to 45 days to process a claim once we submit it. We cannot bill you for a remaining balance until the insurance company officially dictates what your exact responsibility is.
What happens if my claim is denied?
What happens if my claim is denied?
Claims can be denied for several reasons, such as a lapsed policy, an out-of-network plan, or missing referral information. If a claim is denied due to an error on our end, we will correct and resubmit it. If it is denied due to coverage issues, the full balance of the appointment becomes your responsibility.
Important Note: If the claim is denied due to coverage issues, you will not pay more than the contracted rate for the service that we would have received as payment directly from the insurance company.
Key Terms to Know
Understanding your costs comes down to knowing how your specific plan is structured.| Term | What it means |
|---|---|
| Premium | The monthly amount you pay your insurance company to have coverage. |
| Deductible | The set amount you must pay out-of-pocket for healthcare services each year before your insurance begins to pay anything. |
| Copayment (Copay) | A fixed flat fee (e.g., $30) you pay for a specific service, usually due at the time of your appointment. |
| Coinsurance | Your share of the costs of a service, calculated as a percentage (e.g., you pay 20%, the insurance pays 80%) after your deductible is met. |
| Out-of-Pocket Maximum | The absolute most you will have to pay for covered services in a plan year. Once hit, your insurance pays 100% of covered costs. |