Insurance

UNDERSTANDING YOUR MENTAL HEALTH INSURANCE BENEFITS

Most insurance plans provide at least some benefits to help their plan members pay for therapy services. To get the most out of your insurance benefits, it is important to get the right information about what your insurance plan does and does not cover, and what your responsiblities are as a plan member. We strongly encourage all patients who plan to use their mental health insurance benefits for therapy services to contact their insurance provider to get specific information about their plan prior to starting therapy. Even if you are very familiar with your plan's medical benefits, you may find that how your insurance company handles mental health benefits is different.

Checking on Your Benefits To help you determine what your benefits are, and maximize the benefits you receive from your plan, you may wish to download our Checking on your Mental Health Benefits worksheet. This worksheet provides a list of specific questions to ask your insurance company when you call to verify your mental health benefits. With this information, you should be able to determine what your out-of-pocket costs well be and what steps you will need to take to maximize the benefits you receive through your insurance plan. PLEASE NOTE: While we do file insurance claims on behalf of our patients, it is important to keep in mind that that each patient is ultimately responsible for all non-reimbursed costs. Denied claims, deductibles, co-pays, missed session fees, late cancellation fees and all other non-reimbursed costs are the responsibility of the patient.

TERMS YOUR INSURANCE COMPANY MAY USE:
DEDUCTIBLE: This is the amount you must pay out of your own pocket to your therapist before the insurance company will begin making payment to the provider. For instance, if you have a $250 deductible, the first $250 in therapy charges will be payable directly to the therapist by you rather than by your insurer. After you have "met" (paid) the $250 in deductible charges, your insurer will begin paying its portion of charges. Some plans may require that you meet a separate mental health deductible. Be sure to ask your insurer if your mental health and medical deductible are the same. Most plans require you to meet your deductible on a calendar year basis. This means that your deductible is "reset" at the beginning of each year and beginning January 1st you will need to meet a new deductible each year. Some plans run on an annual deductible that does not coincide with the calendar year.
COINSURANCE: Coinsurance is the amount you owe after the insurance company has paid its portion of the charges. For example, if your insurer pays 80%, your coninsurance, or the amount of money you must pay per session, is 20%.
COPAY: A copay is a flat dollar amount that must be paid each time you meet with your therapist. Note: Your mental health copay is often different than the copay for your medical doctor. Many insurance companies list a copay amount on the front of their members' ID cards. It is important to note that this may not be the copay amount due for mental health services - this may be the copay amount for medical or other services.
PRE-AUTHORIZATION: Some insurance plans require that you obtain a pre-authorization (sometimes called a pre-certification) before you see your therapist for the first time. Plans that require such authorization will not pay for visits that have not been authorized in advance, leaving the patient to pay the full fee for unauthorized sessions. If you are required to obtain a pre-authorization for services, please provide us with your authorization number or authorization code before your first session.
IN-NETWORK/OUT-OF-NETWORK: To reduce costs, many insurers develop a network of providers who agree to perform their services for a negotiated rate. To encourage plan members to use services at these negotiated rates, many insurers provide greater benefits to their members when they see an in-network provider. Some plans will pay no benefits for services provided by a therapist who does not participate in their network. Plans may also require you to meet a separate, out-of-network deductible (which is often higher than your in-network deductible) if you seek services with providers outside of their network.
REFERRALS: Some plans, typically HMO plans, require that you obtain a referral from your primary care physician prior to meeting with your therapist. These plans will not pay for therapy sessions for which no referral was obtained. Please present your referral paperwork prior to your first session with your therapist.
SESSION LIMITS/DOLLAR LIMITS: Most plans allow their members a maximum number of therapy sessions or a maximum dollar amount toward therapy sessions each year. Once that limit has been met, all fees for subsequent therapy sessions for the plan year or calendar year become the responsibility of the patient. For instance, if your plan limits your visits to 20 per calendar year, the 21st and all subsequent sessions will not be eligible for any reimbursement by your insurance carrier.

INSURANCE NETWORKS
Some of the networks in which our therapists participate include:
Arkansas Blue Cross/ Blue Shield	AETNA	AMCO
BlueAdvantage Administrators	BlueCard	LifeSynch
United Behavioral Health	Health Advantage	CIGNA (Tyson)
CIGNA Behavioral Health	PHCS	Healthlink
QualChoice	U of A Student Insurance	CoreSource
TriCare*	Washington Regional Employee Insurance
PLEASE NOTE: This is not a complete list and is subject to change without notice. Please contact your insurer to verify your therapist's current participation in your specific plan.

We do not accept Medicaid or Medicare.

*Effective June 1, 2011, Dr. Spaine will no longer accept TriCare.