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Insurance

Health insurance helps pay for mental health care needs including checkups, visits to specialists, emergency care and hospital stays. However, the amount that’s covered and under what circumstances varies from one insurance provider to another and from plan to plan. To help you understand your plan and your eligible benefits, we’ve developed the Insurance Worksheet. We encourage you to complete it and give it to your counselor so that we may help you get the insurance coverage you’re entitled to.

SamaraCare counselors are affiliated with many insurance providers including: Aetna, Blue Cross Blue Shield, Cigna, Coventry, Medicare, Magellan, Tricare, United Healthcare and Value Options. However, different counselors are affiliated with different provider networks. Please ask us or your insurance provider if the counselor you’re interested in seeing is in their network. When you see a counselor who is in-network, the service fee is discounted. If the counselor is out-of-network, the service fee is not discounted.

If you find that your insurance plan does not provide sufficient coverage, please tell us. Having you get the care you need is what’s most important. We’ll work with you and try to develop a financial plan that meets your needs.

Insurance terms and their definition to help you understand your benefits:

In-network

The SamaraCare counselor is contracted with your insurance carrier. Working with an in-network counselor will be based on a discounted rate. The portion due from you may be lower as compared to working with a counselor who is out-of-network.

Out-of-network

The SamaraCare counselor is not contracted with your carrier and you will be billed at the full rate. Out-of-network PPO plans will most often provide coverage at a lower reimbursement rate and will often have a larger deductible. SamaraCare will submit claims to an out-of-network PPO. SamaraCare is not contracted with HMO plans and will not submit claims unless prior authorization is obtained to do so.

Deductible

A deductible is an amount assigned by your policy that must be met before benefits are paid by your carrier. In certain instances deductibles do not apply, such as the case with in-network copays. For this reason, it is important to understand your policy and know your financial obligation with respect to your deductible. Most often, deductibles must be fully met in out-of-network situations before any benefit is paid. Deductibles are your responsibility.

Copays

This is a set fee for in-network office visits. Copays are due at the time of service and are consistent for each date of service.  Often, deductibles do not apply to plans with copays; conversely, copays can be required even after an out-of-pocket limit is met.

Co-insurance

Both in-network and out-of-network plans may have a co-insurance amount rather than a set copay. In this instance, you are responsible to pay a percentage assigned by your plan. In most cases, the deductible must be met before co-insurance applies. For example: if you have a 20% coinsurance, your plan will pay 80% of the allowable amount after your deductible has been met. Once you have met your deductible, you will be responsible for 20% of the allowable rate. Occasionally, a plan can have both a copay and a co-insurance percentage due from the client.

Behavioral Health Benefits

Benefits pertaining to counseling may be covered under a different plan from that of your primary insurance. In this circumstance, SamaraCare will need the billing name and address for claim submission. It is also important to know that benefits provided for behavioral health office visits may vary from benefits provided for medical primary care office visits.

Authorizations

Some plans require pre-approval for behavioral health services. Most in-network plans do not require authorizations; however, it is always best to ask.

Insurance Cards and Plans

Be sure to provide accurate information upon your first appointment and keep your information current. Inaccurate information or lack of information will result in the claim not being processed and it will become the financial responsibility of the client to pay the full amount.

Secondary Insurance

It is important for our billing staff to know if you have a secondary insurance. A secondary plan works in conjunction with your primary plan and reimburses a portion of the financial obligation.

Medicare

When Medicare is accompanied by a secondary insurance, Medicare will automatically bill that plan for you. In cases where there is a deductible with Medicare and/or the secondary plan, you will be billed the deductible. If your secondary insurance is a Medicaid plan, SamaraCare will not bill you for the portion associated with Medicaid.

It is important for us to have all information to bill accurately and in accordance with Medicare/Medicaid. If you are a Medicare client and you choose to work with a counselor who is not in-network, we will require you to sign documents verifying your knowledge of the lack of coverage.