Blue Cross Blue Shield
Mississippi Medicaid (Under 18)
Magnolia & Molina (Under 18)
Magnolia & Molina (Under 18)
How Using Your Insurance Works:
Insurance can be difficult to understand. If you are using insurance for your therapy appointments, we take the worry out of that for you. Once you give us your insurance information, we check your benefits to let you know how much you may owe for each appointment. Please keep in mind that insurance may say that you owe a certain amount and then pay a different amount that you will see on your Estimation of Benefits. If that happens, we will correct it at the next scheduled appointment.
Soulshine Counseling and Wellness, LLC offers insurance verification as a courtesy. However, the information given online or via phone from insurance is often inaccurate. That is not the fault of the healthcare facility. When we tell you what you will owe for each session, that is based on the information we receive from the insurance company.
Once you receive your EOB, Estimation of Benefits, you will see what was owed for the service you received. If you owe less, we will refund you or credit it to your future sessions. If you owe more, you are responsible for paying that. Ultimately, you are responsible for verifying the benefits you have with your insurance company. As stated, we do this as a courtesy, but the liability is yours. If insurance recoups the money you paid Soulshine Counseling and Wellness, LLC you will owe the amount recouped.
The information below is only for education purposes. There are many other facets of insurance and often many exceptions to the information below. Again, please know that you are responsible for knowing your own insurance benefits. Also, you are fully responsible for any and all fees that insurance does not pay the healthcare facility.
Copays are a fixed amount that you pay at each session. The insurance company determines the amount of your copay. There are some insurance plans that do not require you to meet a deductible, but that is rare. Most insurance companies require you to meet your deductible before you'll owe just the copay.
Deductibles are the dollar amounts that insurance companies require you to pay before they begin paying towards your medical treatments. Once you have paid that amount for services, you will then only owe a copay for medical services.
The amount you pay for services before the deductible is met is determined by the insurance company. This is what is called a "contracted rate." Healthcare facilities do not determine the contracted rate. They are legally required to collect the contracted rate until your deductible is met.
Co-Insurance is similar to a copay. Co-Insurance typically takes affect after your deductible is met. However, there are some insurance plans that only require a co-insurance, meaning there is no deductible to meet first. As with copays, that is rare.
Once your deductible is met, your co-insurance will begin. The amount your co-insurance will be is a percentage of the contracted rate set by the insurance company. For example, if the contracted rate for the service you are receiving is $100 and your co-insurance is 20%, you will owe $20.00.
EAP stands for Employee Assistance Program. Some companies offer EAP as a benefit for employees. An EAP allows you to see a therapist for a set amount of sessions at no cost to you. The insurance company sets the number of sessions you will receive for free. EAPs are only for short-term counseling. Once you have used all of your EAP sessions, your insurance will then go into effect with a deductible, copays, or co-insurance.
Out-of-Pocket is the amount of money you have spent in a year for covered healthcare services. This includes copays, co-insurance and deductibles. Once you reach your out-of-pocket maximum, your healthcare services will be covered at 100%. The insurance company determines the dollar amount of your out-of-pocket.
Self-Pay means you are not using insurance for healthcare services. There are two reasons you may do self-pay. The first is that you do not have health insurance. The second is that you have health insurance, but choose not to use it for your healthcare services.
Out-of-Network refers to the healthcare provider not having a contract with your insurance company. If this is the case for your healthcare provider, then you will owe the Self-Pay rate.
Some insurance companies will allow you to submit a Super Bill for reimbursement. The healthcare provider will provide this for you. You can submit the Super Bill to your insurance company and they will reimburse you. The reimbursement typically does not cover the full amount you paid. Also, there are some insurance companies that will not pay for an Out-of-Network healthcare provider.
An HSA, Health Savings Account, is an account that lets you save pre-tax money for qualified medical expenses. HSAs often exist for insurance plans with a high deductible. Typically, if you don't use all of the money in your HSA by the end of the year, it can roll over for the following year. In most scenarios you are required to submit invoices when using HSA money. Your healthcare provider can provide the invoice for you to submit.
An HRA, Health Reimbursement Arrangement, is an IRS-approved health benefit that is funded by an employer. An HRA can be used to assist deductibles, copays and out-of-pocket medical expenses. Employers contribute tax-free money to employee's HRAs to help their employees with medical expenses. Typically, an HRA requires invoices to be submitted to justify the proper use for medical services.
Non-Covered Medical Services are medical services of which your insurance will not pay. If you receive medical treatment for a Non-Covered Service, you will have to pay the provider for the service. It's best practice to contact your insurance company prior to receiving any medical treatment to make sure that treatment is not a Non-Covered Service.