As the new year begins and open enrollment ends, it’s a great time to revisit your health insurance benefits to ensure there are no surprises when it comes to paying for therapy. Here are the key points to keep in mind:
1. Deductibles May Reset
Most insurance plans operate on one of two schedules:
- Calendar Year Plan: These plans start on January 1st and end on December 31st. If your plan follows this schedule, your deductible will reset on January 1st. This means you will need to pay out of pocket for each session until you meet your deductible before your insurance begins to cover a portion of the cost.
- Contract Year Plan: These plans renew based on the date your coverage began (e.g., October 1 to September 30). For these plans, deductibles reset on the anniversary of your coverage start date.
To confirm your plan’s schedule, check with your insurance provider by calling the number on the back of your insurance card. Ask specifically when your deductible resets and what the amount is for both in-network and out-of-network providers.
2. Copays and Coinsurance May Change
At the beginning of a new calendar year or contract year, insurance companies often make adjustments to their plans, which may include changes to copays, coinsurance rates, coverage limits, or other coverage details. These updates can directly affect the cost of your therapy sessions and how your benefits are applied. To ensure a smooth continuation of care, it’s important to:
- Confirm your updated copay or coinsurance for therapy sessions: This helps you understand your financial responsibility for each session.
- Check for any changes to the number of covered sessions or policy limits: Some plans may adjust the total number of sessions covered annually or set new restrictions.
- Update your therapist with this information: If any of these changes impact billing or payment, notifying your therapist promptly ensures accurate billing and prevents disruptions in care.
These changes can significantly affect the cost of your therapy sessions and how your benefits are utilized, making it essential to understand your coverage and feel confident navigating any adjustments.
3. Superbill Submission Deadlines
If you’re working with an out-of-network provider and submitting superbills for reimbursement, keep these tips in mind:
- Check the deadline for submitting claims: Each insurance company has its own rules and specific timeframes for submitting claims. Missing these deadlines can result in denied reimbursement, so it’s essential to know and adhere to their policies.
- Request any outstanding superbills from your therapist as soon as possible: If you have sessions that haven’t yet been billed to your insurance, ask your therapist for the necessary documentation promptly to avoid delays in your claim submission.
- Ensure all required information is included on the superbill: Double-check that the superbill contains all essential details, including the provider’s name, credentials, and NPI number, the service dates, CPT codes, session fees, and any other information your insurance requires. This ensures a smoother claims process and reduces the likelihood of rejection.
4. Budget for the New Year
Understanding your insurance benefits helps you budget for therapy costs:
- If you haven’t met your deductible yet, plan for out-of-pocket costs until you do. Your Good Faith Estimate will help you do this!
- Once your deductible is met, calculate the ongoing cost based on your copay or coinsurance.
- Use this information to plan your therapy schedule and manage financial expectations.
5. Stay Updated
Insurance policies can change year to year. It’s essential to:
- Review any new policy documents sent by your insurance company.
- Inform your therapist of any changes to your coverage, copay, or deductible.
- Keep track of your insurance usage and remaining benefits throughout the year.
Taking a few moments to check in with your insurance provider or your therapist directly can save you time, money, and stress. If you have questions about your benefits or need assistance understanding your superbill, don’t hesitate to reach out to your therapist or their billing team for guidance. Here’s to starting the new year informed and ready to prioritize your mental health!