How does health insurance work?
Health insurance is provided when you enroll through your employer, the healthcare exchange, or through the DHS for state funded plans. It involves a contract between you and your insurance company. When you are enrolled with an insurance company, you are a member of that plan and are provided with an insurance card and documents relating to your coverage. While most individuals that are insured only carry one insurance plan, others possess secondary insurance which is insurance acquired to offset health costs not covered by the primary (main) insurance.
You are responsible for providing us with your correct insurance information, notifying us of changes in coverage, notifying us if you have another insurance provider (some people have secondary insurance), and also signing an Insurance Authorization Form at the start of services (it is included in intake packet) and any time insurance coverage changes.
After you provide us with your insurance information we will verify your insurance and if we see that you have cost sharing (see below) as part of your plan, we will require you to add your credit card through the secure portal. This is to ensure that your provider is able to be reimbursed for the work that they do, and you are charged in accordance with what your insurance plan indicates to be your responsibility.
You are responsible for providing us with your correct insurance information, notifying us of changes in coverage, notifying us if you have another insurance provider (some people have secondary insurance), and also signing an Insurance Authorization Form at the start of services (it is included in intake packet) and any time insurance coverage changes.
After you provide us with your insurance information we will verify your insurance and if we see that you have cost sharing (see below) as part of your plan, we will require you to add your credit card through the secure portal. This is to ensure that your provider is able to be reimbursed for the work that they do, and you are charged in accordance with what your insurance plan indicates to be your responsibility.
Premium: Individuals with health insurance through their employer or through the exchange usually pay a monthly premium. This premium ensures that coverage is not interrupted. The amount of your premium depends on your specific choice of plans and usually resets every year. Like auto and home insurance, health insurance requires you to provide a payment each month to make sure your coverage isn’t interrupted.
According to the plan that is chosen, Health insurance companies identify different networks or tiers of care for the health plans that they offer. Some may require members to select a primary clinic or health group's clinics (for example only Fairview clinics); meanwhile, others may allow members open access to book appointments with any In Network provider and still have coverage.
Plan Benefits:
Covered Services: Health care services that your insurance plan will pay for or cover.
Excluded Services: Health care services that your health insurance or plan doesn’t pay for or cover.
One of the most important things to ask about when you are comparing insurance plans is cost sharing.
Cost Sharing: This term refers to the breakdown of expenses between you and your insurer. Some plans require cost sharing and others may not. These are different types of cost sharing:
In Network: Clinics that contract with your health insurance or plan are referred to as In-network providers. Seeing providers that are in network with your insurance is often the best way to reduce cost to members.
The Luminous Mind is contracted with the following health insurances: Aetna, Blue Cross Blue Shield, Health Partners, Ucare, Medicaid, and Medicare Plan B. This does not mean that anyone with these insurances automatically can assume that their care will be covered as the specifics of their coverage still depends on their specific plan. The best way to ensure coverage is to call your insurance and ask them about your plan's coverage. When you call to get this information they will ask you for The Luminous Mind's National Provider Identifier (NPI) which is: 1588015168
Out of Network: Clinics/Providers that do not have contracts with your specific insurer are referred to as being out network.
Explanation of Benefits (EOB): This is a statement generated by a health insurance plan after they have processed claims submitted by your provider. They are sent directly to the member describing what costs it will cover for the specific services received.
Coordination of Benefits (COB): Your insurance company will often request for you to call them indicating that they need to obtain COB information. What this often entails is them asking about whether you have any other insurance coverage so that they can figure out who pays first when two or more health insurance plans are responsible for paying the same claim.
Prior Authorization: Some insurance plans require that your provider obtain approval before certain services are provided. If a plan requires a prior authorization, it needs to be received before services are rendered in order for the service to be covered by the insurance plan.
If you are interested in receiving services at The Luminous Mind but we are Out of Network for you have the following options:
Find an In-Network Provider: You can contact your insurance plan to ask about providers in your network that provide the same services that you are seeking.
Request a Single Case Agreement (SCA): SCAs are contracts between an insurance company and an out of network provider. These types of contracts typically cover a specific client receiving a service for a designated amount of time at an agreed upon rate. Every insurance company is different in their policies and procedures around obtaining SCAs.
Utilize Out-of-Network Benefits: Sometimes after consulting with their insurance plan, individuals want to use their out of network benefits. In this case, we are happy to provide client's with superbills or we can submit directly to their insurance. Clients that elect this option will be required to sign two federally required documents before services can begin:
A. Surprise Billing Protection Notice Form and Waiver
B. Good Faith Estimate
Pay Out of Pocket: Sometimes clients who are uninsured or who don't want to utilize Out-of-Network coverage prefer to privately pay for services. If you elect to pay privately you will be given the option of completing a Sliding Fee Application to help off set the financial burden to you. You will also be required to complete two federally required documents before services can begin:
A. Surprise Billing Protection Notice Form and Waiver
B. Good Faith Estimate
-Please note: If you opt out of using your insurance for whatever reason and you decide to pay of pocket for services, we will not back bill for services that have already been paid for.
According to the plan that is chosen, Health insurance companies identify different networks or tiers of care for the health plans that they offer. Some may require members to select a primary clinic or health group's clinics (for example only Fairview clinics); meanwhile, others may allow members open access to book appointments with any In Network provider and still have coverage.
Plan Benefits:
Covered Services: Health care services that your insurance plan will pay for or cover.
Excluded Services: Health care services that your health insurance or plan doesn’t pay for or cover.
One of the most important things to ask about when you are comparing insurance plans is cost sharing.
Cost Sharing: This term refers to the breakdown of expenses between you and your insurer. Some plans require cost sharing and others may not. These are different types of cost sharing:
- Deductible: This is the dollar amount that you need to pay at the start of your coverage every time your insurance starts or resets and is what you need to pay before your insurer starts to pay for covered services. Once you meet this deductible, your insurance will start to cover costs according to your plan.
- Co-insurance: Some insurance plans require you to pay a percentage of certain costs and hold you responsible for the remainder - this is called coinsurance.
- Co-payment: This is a fixed dollar amount to be paid at each visit (session). This amount when present is decided by your insurance company and requires to pay it at the time of the appointment.
- Out-of-Pocket Maximum: This is a dollar amount set by your insurer for your specific plan and is the maximum you will pay out of pocket in a year. Your deductible, coinsurance and co-payments are added up to compute your out-of-pocket maximum. After you meet your out of pocket maximum, your plan will pay for everything else (except for your monthly premium).
In Network: Clinics that contract with your health insurance or plan are referred to as In-network providers. Seeing providers that are in network with your insurance is often the best way to reduce cost to members.
The Luminous Mind is contracted with the following health insurances: Aetna, Blue Cross Blue Shield, Health Partners, Ucare, Medicaid, and Medicare Plan B. This does not mean that anyone with these insurances automatically can assume that their care will be covered as the specifics of their coverage still depends on their specific plan. The best way to ensure coverage is to call your insurance and ask them about your plan's coverage. When you call to get this information they will ask you for The Luminous Mind's National Provider Identifier (NPI) which is: 1588015168
Out of Network: Clinics/Providers that do not have contracts with your specific insurer are referred to as being out network.
Explanation of Benefits (EOB): This is a statement generated by a health insurance plan after they have processed claims submitted by your provider. They are sent directly to the member describing what costs it will cover for the specific services received.
Coordination of Benefits (COB): Your insurance company will often request for you to call them indicating that they need to obtain COB information. What this often entails is them asking about whether you have any other insurance coverage so that they can figure out who pays first when two or more health insurance plans are responsible for paying the same claim.
Prior Authorization: Some insurance plans require that your provider obtain approval before certain services are provided. If a plan requires a prior authorization, it needs to be received before services are rendered in order for the service to be covered by the insurance plan.
If you are interested in receiving services at The Luminous Mind but we are Out of Network for you have the following options:
Find an In-Network Provider: You can contact your insurance plan to ask about providers in your network that provide the same services that you are seeking.
Request a Single Case Agreement (SCA): SCAs are contracts between an insurance company and an out of network provider. These types of contracts typically cover a specific client receiving a service for a designated amount of time at an agreed upon rate. Every insurance company is different in their policies and procedures around obtaining SCAs.
Utilize Out-of-Network Benefits: Sometimes after consulting with their insurance plan, individuals want to use their out of network benefits. In this case, we are happy to provide client's with superbills or we can submit directly to their insurance. Clients that elect this option will be required to sign two federally required documents before services can begin:
A. Surprise Billing Protection Notice Form and Waiver
B. Good Faith Estimate
Pay Out of Pocket: Sometimes clients who are uninsured or who don't want to utilize Out-of-Network coverage prefer to privately pay for services. If you elect to pay privately you will be given the option of completing a Sliding Fee Application to help off set the financial burden to you. You will also be required to complete two federally required documents before services can begin:
A. Surprise Billing Protection Notice Form and Waiver
B. Good Faith Estimate
-Please note: If you opt out of using your insurance for whatever reason and you decide to pay of pocket for services, we will not back bill for services that have already been paid for.
