Everything You Need to Know
Insurance FAQ's
General Insurance & Coverage Questions
Which insurance plans do you accept?
We proudly accept the following insurance plans:
- Blue Cross Blue Shield (BCBS)
- Cigna
- Aetna
- Tricare
Insurance Plans We Do Not Accept
At this time, we are unable to accept Medicaid, United Healthcare/Optum, Oscar, or UMR.
Medication Coverage
Even if we don’t accept your insurance plan for visits, you can still use your benefits to cover your medications.
Affordable Care Without Insurance
For those seeking flexibility, our subscription plan is an excellent alternative. For just $129/month, you can access comprehensive telehealth visits without relying on insurance.
- Use your HSA card to make the subscription plan even easier to manage.
What should I do if I suddenly find myself without insurance that you accept?
If we are unable to accept your insurance, don’t worry—we offer affordable options to ensure you still receive quality care.
Our subscription plan is an excellent alternative, providing telehealth visits for just $129/month, along with discounted rates for additional visits.
This allows you to access care without relying on insurance.
What happens if my insurance changes in the future?
If your insurance changes, you can continue using our subscription plan to access care. Should your new insurance cover our services, we’ll work with you to transition back to using your insurance if that’s your preference.
What happens if my care is considered out-of-network (OON)?
If your insurance considers WMHS OON…
- You can use our subscription plan to access care at predictable rates.
- Some insurance plans allow partial reimbursement for OON services—ask your insurance provider for details.
- Choose our subscription plan, as our pricing is transparent and straightforward.
- Use your HSA benefits to Self Pay for care.
- If you were told ONN but you think its a mistake use this letter to clarify your benefits. Benefit Clarification Sample Letter
- Use this letter to Ask my employer to provide better benefits.
How do subscription payments apply to my deductible?
While subscription payments don’t count as insurance claims, many insurers allow self-pay expenses, like those for our subscription, to count toward your deductible. Contact your insurance provider for verification.
HSA, Employer Benefits, and Our Subscription
How can I maximize my HSA benefits for healthcare expenses?
To make the most of your HSA:
Contribute the maximum allowed amount annually ($4,150 for individuals, $8,300 for families in 2024).
Use HSA funds to cover subscription costs and other qualifying healthcare expenses.
Track your expenses to ensure every dollar is working toward your health needs.
How do I add more to my HSA through my employer?
If your employer offers HSA contributions:
Log in to your benefits portal to adjust your payroll contributions. Even a small increase—like $15.00 per paycheck—can make a big impact over time. Since these contributions are pre-tax, you’ll notice less of a difference in your take-home pay.
Be sure to ask your HR department if your employer offers matching contributions. If they do, increasing your contribution to maximize the match is one of the easiest ways to grow your HSA savings faster. Take full advantage of this benefit—it’s like free money for your healthcare!
How do I verify my employer’s benefits?
Benefit Clarification FormThe very best way to know your coverage details is to ask your HR department directly. To assist you, we’ve created a pre-written letter you can send to your HR team. This letter helps clarify questions about your insurance, HSA contributions, telehealth coverage, and wellness programs.
Benefit Clarification Sample Letter
Additionally, you can:
- Review your benefits guide or employee handbook.
- Log in to your online benefits portal for detailed plan information.
- Contact your HR or benefits coordinator directly with any questions.
How can I ask my employer to provide a mental health subscription as part of our benefits?
Start the conversation by explaining how a subscription could benefit both employees and the company:
- Reduced stress and absenteeism.
- Affordable care for employees with high-deductible plans. Here’s a sample request you can use:
“I’ve found a mental health care subscription that provides affordable and accessible care. It could be a valuable addition to our benefits package. Could the company consider sponsoring or partially covering these subscriptions for employees?
Use this sample letter to Ask my employer to provide subscription.
Specific Insurance Scenarios and Coverage Options
What if my insurance plan has a high deductible?
Our subscription model is designed to reduce the financial burden of high deductibles. You pay a flat monthly fee for care instead of large, upfront out-of-pocket expenses.
Additionally, payments can often count toward your deductible and you can use your HSA card for the monthly fee—check with your employer/insurance plan for details.
What are my options for continuing care with your practice now that WMHS is no longer in-network with UHC?
We made the difficult decision to end our partnership with UHC to protect your privacy and ensure your care is never compromised. Their overreaching requests for sensitive mental health records and potential HIPAA violations left us with no choice but to prioritize your well-being over compliance with their unreasonable demands.
You are worth prioritizing, and your mental health matters too much to get caught up in the frustrating red tape of the insurance bureaucracy. That’s why we launched our subscription plan—to provide a clear, affordable alternative that ensures you continue receiving the care you deserve.
What our subscription plan includes:
- Affordable Access to Care: For $129/month, you’ll receive ten telehealth visits per year, with discounted rates for additional care.
- Peace of Mind: No surprise bills, no hoops to jump through—just reliable, consistent support.
- Empowered Choices: Freedom to focus on your health and wellness on your terms, without unnecessary interference.
We started this plan to address the challenges created by insurance barriers and are committed to adding even more value. Exciting enhancements are planned for 2025!
What if I have Medicare—what are my options?
We welcome Medicare patients, but it’s important to understand the following:
- Medicare Coverage: If Medicare is your primary insurance, please check your plan to confirm whether we are considered in-network or if you have out-of-network benefits.
- Out-of-Network Patients: If we are out-of-network, you may still access care through our subscription plan. However, Medicare does not reimburse subscription payments.
- Secondary Insurance: If Medicare is your secondary insurance, please verify with your primary insurance whether they will cover services with us. If not, this may require a provider transition.
Are there other options for affordable care if I’m on Medicaid?
We do not accept Medicaid as primary insurance. If Medicaid is your secondary insurance, we may be able to continue your care depending on your primary insurance payment policies. However, if your primary insurance does not pay, it could result in dismissal from the practice—a situation we strive to avoid as it is dissatisfying for all parties involved.
Additionally, Medicaid regulations prohibit patients from paying out-of-pocket for medical services or enrolling in subscription plans. If you are on Medicaid, we recommend the following steps:
- Review Your Plan’s Provider Directory: Use the online directory to locate in-network providers who can address your needs.
- Explore Community Health Programs or Clinics: These resources often provide affordable or no-cost care options.
- Check Psychology Today for other providers that accept Medicaid.
- Coordinate With Your Primary Care Provider (PCP): We can collaborate with your PCP by providing recommendations or treatment summaries to ensure your care is transitioned smoothly.
For additional resources, visit Allies Network
Billing, Payment Plans, & High Balances
What should I do if I have a high balance that I expected my insurance to cover?
Start by reviewing your Explanation of Benefits (EOB) to understand why the claim wasn’t paid. Common reasons include unmet deductibles, out-of-network services, or errors in processing.
If you believe there’s a mistake, contact us to review the claim. To allow us to act on your behalf, submit a signed Assignment of Benefits Request. Which allows us to work with your insurance provider to understand the issue. During this time we may require a payment plan to be in place to protect you from accumulating high balances. Any overpayments will be refunded if the issue is resolved.
Do you offer payment plans to help manage outstanding balances?
Yes, we offer flexible payment plans to help you manage high balances. You can self-initiate a payment plan at any time through your Athena portal or contact our office if you need additional assistance setting it up. We’re here to make care affordable and manageable for you.
