What does it mean to be an in-network provider?

Being in network means we have a contract with your insurance company to:

• Provide services at agreed-upon rates

• Submit claims directly to your insurance for reimbursement

When we are in network with your plan, your insurance typically covers a portion of the cost of services, and you are responsible for any copayment, coinsurance, or deductible outlined by your specific plan.

Out-of-network benefits

If we are out of network with your insurance plan but you have out-of-network benefits, we can provide a superbill upon request. A superbill is a detailed receipt that you may submit to your insurance company for possible partial reimbursement. Reimbursement is determined solely by your insurance plan.

Verification of benefits

Upon receiving your insurance information, our billing team will complete a verification of benefits prior to beginning treatment. This process helps identify:

• Whether we are in network with your plan

• Your estimated copayment or deductible

• Whether prior authorization is required

While we assist with this process, clients are ultimately responsible for understanding their insurance coverage. Insurance companies determine benefits, coverage limits, and payment decisions.

Questions about your:

• Copayment

• Deductible

• Coinsurance

• Coverage limits

should be directed to the member services number on your insurance card. Our team is happy to guide you on what questions to ask and where to find this information.

Coordination of Benefits (COB)

Coordination of Benefits applies when a client has more than one health insurance plan (for example, coverage through a parent, spouse, employer, or school).

Insurance companies require clients to confirm which plan pays first. If this process is not completed:

• Claims may be denied or delayed

• Insurance may not issue payment

• Clients may become financially responsible for services

Even if you believe your insurance companies already have this information, they require direct confirmation from the client. If a Coordination of Benefits issue arises, we will address it during session time to prevent ongoing billing problems.

Client responsibility

Clients are responsible for:

• Providing accurate and current insurance information

• Notifying us of any changes to insurance coverage

• Completing any required Coordination of Benefits with their insurance plan

• Paying any balances not covered by insurance

Verification of benefits should also be completed again if your insurance changes at any time during treatment.

Good Faith Estimate (Self-Pay Clients)

When paying out of pocket, you have the right to receive a Good Faith Estimate explaining the expected cost of your care.

Under federal law, healthcare providers must give patients who do not have insurance or who are not using insurance a written estimate of expected charges for non-emergency services.

You have the right to:

• Receive a Good Faith Estimate for the total expected cost of services

• Request this estimate at least 1 business day before your appointment

• Ask for a Good Faith Estimate before scheduling services

If you receive a bill that is $400 or more above your Good Faith Estimate, you may dispute the bill. Please keep a copy of your estimate for your records.

For more information, visit www.cms.gov/nosurprises or contact our office at 805-697-4488.

Next steps

Verification of benefits is completed prior to starting treatment. Please complete the insurance information form linked above to ensure your benefits are verified accurately.