Insurance 101

Andrea Reilly, Director of Billing October 18, 2021

Health insurance is complex, but Humantold’s expert is here to help you with this essential step toward better well-being.

Deductible, out-of-network provider, premium, and in-network provider—it’s a world filled with jargon. Many people just need simple answers to key questions. Does health insurance cover therapy? Will I be paying for treatment out-of-pocket?

Insurance Can Be Confusing 

If you have ever felt confused by insurance, you’re not alone. According to Forbes, a recent study shows that 56% of healthcare consumers feel “completely lost” when it comes to actually understanding their benefits and insurance options. 

Let’s face it, the entire concept of health insurance is a confusing one. People’s eyes instinctively glaze over when they hear “health insurance” or “explanation of benefits.” Worse, the fear of paying for therapy out-of-pocket scares many people away from getting the mental health services they need.  

The Complexities of Medical Billing

I have spent over 25 years navigating the mysterious realm of medical billing. I started in pediatrics and orthopedics but eventually found my niche in mental health. But no matter the specialty or expertise of a seasoned professional in the medical field, rules and regulations are ever-changing. 

At Humantold’s medical billing department, we do our best to stay on top of these changes because it makes such a positive impact for people seeking therapy. Through the years and after all the medical/mental health practices I have worked with, there has been one constant theme: healthcare is perplexing.

Humantold’s medical billing and client services departments can assist you in making educated and informed choices when it comes to selecting a healthcare plan. We can explain why your insurance company paid a specified bill and not another. Know that, yes, this is baffling not just to you but many, many other people. We are here to guide you, so you don’t have to go at it solo.

The Essentials of Insurance

So, you are on the quest to be in the know when it comes to insurance? Here are three of the most frequently asked questions we encounter from clients:

1.  Why shouldn’t I just choose the cheapest option my employer offers—an in-network plan only?

As the saying goes, “you get what you pay for.” In-network plans are designed to provide coverage for the small percentage of our population that does not tend to use medical or mental health services (infrequently or even not at all) or for those who use health insurance as more of a safety net (just-in-case situations). 

Chronic diseases and conditions (both physical and psychological) are on the rise worldwide. It makes the most sense to have a plan in place that covers your needs, whatever they may be—and with any healthcare professional of your choosing, no matter if that professional decides to participate with your insurance plan or not. 

The main difference is that in-network providers have a specific contract with a particular health plan and accept the insurance company’s rate for a particular service. These rates are typically much less than what is “usual and customary.” They may lead to a decrease in providers willing to join a particular panel or, in some cases, lesser quality of care. 

What this also means is that in-network providers must abide by all rules stated by the insurance company. You will find many exclusions within in-network-only plans. For example, the provider will only allow a certain number of mental health visits per year, or in some cases, none. Alternatively, they may only allow a particular number of acceptable diagnoses for coverage. 

While you may save money up front with a lower premium (or what you pay insurance companies in exchange for coverage), you might wind up spending much more in the long run because you pay out-of-pocket for the healthcare you need most. In other words, you might be paying out-of-pocket fees that your plan does not cover.

2. I was under the impression you were in my network because you said you worked with my insurance plan.

Humantold’s clinicians are “out-of-network providers.” Simply put, we choose not to contract with any insurance company as an in-network provider. We believe in the well-being of our clients and developing ongoing, trusting relationships with them. We cannot fully invest in our clients if we must limit the number of visits they receive, constantly seek authorization for services, or deal with incessant paperwork.

Our clinicians and staff value you and your time—we want to fill it with what you came to us for in the first place—supporting your mental health. 

If your plan offers out-of-network coverage, we will work with them to the best of our ability. We investigate each benefit that comes our way when you first inquire about therapy services through our intake department. 

Humantold does the legwork of finding out precisely what your coverage is and what it provides. We do an extensive analysis of what your insurance will pay so that we can offer you affordable options and services that are best for you.

3. I received a bill from my insurance company that says I owe money. What do I do now?

This question addresses a common misconception. What you received is not a bill; it’s an explanation of benefits (EOB). An EOB is a formal explanation of the benefit your insurance may or may not have paid. EOBs demonstrate the amount a provider charged for a particular service, what the healthcare plan allowed for that service, and the difference between those amounts. 

Remember, it’s not a bill from your provider. It’s also not a bill from your insurance company. If you are unsure of anything stated in your EOB, feel free to give our billing or client service department a call. We are happy to assist you in becoming a more knowledgeable consumer.

Please get in touch with us with any questions you have, no matter how complicated or simple they are. We can assist you with things like choosing a new plan during re-enrollment, explain your most current EOB, break down insurance terms and how they apply to you, and anything else that’s confusing. 

The billing team at Humantold is constantly in a state of learning when it comes to medical billing and insurance, but that does not mean our clients have to be on a confusing carousel. We are here to be as transparent as possible and share what we know. We will help you along the way.

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