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.

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.

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.

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.

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.

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

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.

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.

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.