Insurance and Payment

 

MACS has therapists that accept: Aetna, BCBS, Cigna, CBHA, Medcost, MHN, Bright Health and United Healthcare.  However, not all therapists are paneled with all insurance companies. Please make sure you check with our Intake Coordinator when scheduling your appointment.

ACCEPTING INSURANCE

The Details You Need to Know 

 

Health Insurance is hard to understand and confusing for almost everyone.  You may have coverage, but you have no idea if it will cover mental health and how much your out of pocket costs will be.

 

Our MACS Office Manager and Billing Manager will take your policy information and request a quote from your insurance company if your Therapist accepts insurance.  We can usually get a good idea about your coverage.

 

Here comes the confusing part - Each company's benefits, eligibility, deductibles, copayments, co-insurance, and out of pocket costs vary as does each specific policy (there can be hundreds) within the company. Its very difficult to understand, however these are the important points to remember:

  • Simply because your insurance company has provided a quote of coverage, it is not a guarantee of coverage or payment of services.  All claims will be decided by the insurance company when they process the claim.  You continue to be financially responsible for the payment of all services you receive regardless of insurance denials or issues.Each of our clinicians must meet insurance credentialing & contracting requirements to accept each individual insurance.

  • If you have a secondary insurance, from a spouse, other parent, a supplemental policy-- you must notify us. Failure to bill your secondary insurance will result a payback occurring from the first insurer.  If too much time has passed, the primary insurers can deny the claim as well as the secondary insurers and you will be responsible for the entire bill. This is prevented by disclosing all insurance polices.

  • Not all clinicians are paneled with all insurance companies.  Even some clinicians that are listed as paneled on insurance sites may have decided to  not longer accept insurance because of extremely low reimbursement rates. Please make sure you check with reception at each appointment. 

  • Not all clinicians can accept you as a client just because your insurance is listed. You may have to be placed on a waiting list or referred to another clinician for a quicker appointment. 

  • Some insurance companies use an entirely different insurance company to administer and manage their Mental Health Benefits. This is called a "Carve Out".  This can further complicate your benefits as your provider will also have to be in-network with this secondary company as well. 

  • Just because you clinician is "in-network" with your insurance company does not mean they can accept all plans.  This is the insurance company's decision which plans a provider can accept.

  • The insurance company has the right to ask to review your record that can include details of your sessions in order to determine if the services it is paying for, has paid for or will pay for are medically necessary according to its judgement and policy limitations. 

  • Insurance companies have the right and often practice review of paid claims and can seek that claims paid to the provider be returned for up to 2 years- even if it was the insurance company that made the mistake.  In that situation, you will be contacted and required to pay the amount recouped by the insurance company to MACS.

  • All clients should contact customer service prior to the beginning of therapy to verify benefits and ask questions about your MH outpatient in the office benefits. Questions to ask:

  1. Please tell them you are inquiring about your "Mental Health Benefits" 

  2. Does this insurance company administer my Mental Health Benefits?  If not, what company does?

  3. Is McCloud Acosta Clinical Services or my provider (give therapist's name) an in-network provider for my policy?

  4. If they are not in-network, do I have out of network benefits and what are they?

  5. Is there a secondary insurance listed?  If yes, please ask for details.

  6. What are my outpatient in the office benefits?

  7. What must I pay out of pocket before my insurance covers any charges  (deductible)?

  8. Do I have co-insurance and if so, how much?

  9. Do I have a copayment and if so, how much?

  10. Do you cover service codes 90791, 90837, 90834, 90832, 90839, 90840, 96127, 90785, 90846, 90847, 90887, 90885 and 90889?

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Payment

Payment is due at the time of service.

 

Cash and Check is the preferred method of payment however COVID prevents point of service collection therefore all clients are required to keep an active credit card or debit card on file at all times.

 

Credit Cards, Debit Cards, HSA and FSA Cards are accepted however there is a 4% service fee added to cover the cost of processing.

 

If you wish not to pay this fee, please pay by cash or a check.  You will not able able to be seen for the next appointment until payment is received.

 

Returned checks are charged an additional $50 fee in addition to the amount of the check.

 

All services unpaid after 3 months are referred to a collection agency for collection. 18% interest is added to unpaid invoices every 30 days left unpaid.