How does LLPW handle billing?
1) First, your therapist (or, for Nurse Practitioners, their area manager) will send you a few documents to fill out online, including documents regarding your insurance and payment information.
2) Therapists do check your benefits, but the insurance carriers do not fully stand behind the information they provide us. It is always a good idea to give your insurance a quick call to make sure you are cleared to be seen at LLPW and to check on what your likely client responsibility will be (deductible, coinsurance, or copay – two standard service codes to check are 90791 and 90837).
3) Next, your therapist will bill your insurance (or bill you if you are paying privately) following each of your services (this is called sending a claim). And then we wait for insurance to process your claim (generally 1-6 weeks after billing) and determine your responsibility. Private pay billings are charged at the end of each week.
4) Finally, there is the matter of paying for your portion of the service (deductible, coinsurance, copay).
How does LLPW handle client payments?
Clients have two options for paying their portion of the service.
1) They can either pay their clinician in session with cash or check AT THE TIME OF SERVICE (some, but not all, clinicians accept payment. Nurse Practitioners never accept payment), or…
2) They can opt for what the vast majority of clients choose – autocharge. AUTOCHARGE IS THE DEFAULT OPTION AT LLPW.
When you are on autocharge, we bill insurance (should you have insurance) and once insurance determines your responsibility (generally 1-6 weeks after billing) your credit card on file is charged with a credit card fee (3.5%, except for HSA/FSA cards). With autocharge, there will never be a balance or a credit on your account, you never have to remember cash or checks, and you never have to take up valuable session time paying for your service. Simple and elegant.
NOTE: LLPW does not send regular invoices for services EXCEPT in the case of parents paying for their children’s or adult children’s services.
What happens when I have a question about a charge, need a receipt for insurance, or I need to do something like update my address, insurance, or credit card on file?
Please contact your therapist (or the Nurse Practitioner area manager at firstname.lastname@example.org) right away. S/he will be able to help you or direct your question to the appropriate person at the practice.
Why am I sometimes charged different amounts at different times?
There are many reasons you may be charged different amounts at different times.
1) You may have been charged for more than one date of service at one time (see “How do I read my receipt?” below). This is because insurance processed more than one date of service at one time.
2) Your deductible may have been exhausted and now you only have a smaller copay or coinsurance. Similarly, your insurance plan year may have restarted and NOW you’ve switched from a copay/coinsurance back to a higher deductible.
3) You may have a coinsurance. A copay is a flat fee while a coinsurance is a percentage of the service. So, depending on the code your therapist bills that best corresponds to the service you received, you may have a different coinsurance percentage owed.
4) Your therapist billed a complexity code because the service you received involved more complex communication than services usually entail. Please discuss this further with your therapist.
How do I read my invoice?
(REMEMBER, LLPW does not send regular invoices for services EXCEPT in the case of parents paying for their children’s or adult children’s services.)
Here’s a quick orientation to the LLPW Invoice
1) Your amount due can be found in top right corner of every page (circled in red). And the LLPW mailing address can be found in the top left corner of each page (circled in green).
2) Your date of service, type of service, and therapist are highlighted in dark gray.
3) All insurance activity, including any payment, is listed in the columns highlighted in light gray.
4) All client activity, including payment, is listed in the columns with no highlighting.
5) Your balance for each date of service is listed in the far right column (in red box).
6) If your client balance is zero, it either means that you have paid for that service OR that insurance has not yet processed that service. You can tell by looking at the insurance payment column highlighted in light gray – if there is no payment or discount, insurance has not yet processed the claim and determined your responsibility.
In the example below, the $0 client balance for a 5/29/19 date of service is circled in red. In the green box, you can see that insurance was charged $225. Insurance did not pay anything for the service as this client has a deductible, but insurance did discount the service by $89.15. Then, in the blue box, you can see that the client was charged the remaining amount after the insurance discount, $135.85, AND that the client made a payment of $135.85. That is why the client has a $0 balance for that date of service.
Why do you have my credit card on file?
The vast majority of clients at LLPW pay for their services (private pay or client responsibility after insurance has processed a claim) by autocharge. AUTOCHARGE IS THE DEFAULT PAYMENT METHOD AT LLPW. Autocharge works like this: after insurance processes your claims, we charge your card on file for the portion of the service that insurance has determined is your responsibility – this could be your deductible, copay or coinsurance.
With autocharge, there will never be a balance or a credit on your account, you never have to remember cash or checks, and you never have to take up valuable session time paying for your service. Simple and elegant.
Even if a client chooses to pay with cash or check at time of service, s/he is still required to have a card in file in case s/he forgets a payment, incurs a late cancel fee, or discontinues therapy with a remaining balance.
There is a 3.5% credit card fee for all credit card payments except for HSA/FSA payments.
PLEASE DISCUSS THESE POLICIES AND YOUR OPTIONS WITH YOUR THERAPIST.
Why do you charge a credit card fee of 3.5%?
Our credit card processing system charges us both a flat rate AND a percentage (3.5%) for each payment we run. Additionally, the practice pays for a professional to process insurance payments and client payments. The practice covers the flat rate for each payment AND the cost of the professional to process insurance payments and client payments and the client covers the percentage for each payment.
Again, no fees can be charged to HSA/FSA cards.
If I pay with my HSA/FSA card by autocharge, why do I also need to have a regular, non-HSA/FSA card on file?
Most charges you incur at LLPW can be covered by your HSA/FSA funds. However, late cancel and no show fees cannot be charged to HSA/FSA cards. Additionally, most HSA/FSA cards eventually run out of funds and, when that happens, your regular card will be charged for your service so there is no delay in payment to your therapist.
How do I read my receipt?
Each time you are charged for your portion of your service, you will receive a Square receipt. That receipt will list not only the amount you are being charged, but also your first name, last initial, and the date of service for which you are being charged. See the example receipt below.
This is all very helpful information because we only charge you for your portion of insurance after insurance processes your claim – about 1-6 weeks after billing for your service.
What do you mean by “deductible,” “copay,” and “coinsurance”?
Most, but not all, insurance plans generally start with a fixed deductible that you will need to exhaust each insurance year (12 months from the start of your insurance) BEFORE insurance will cover services. This deductible could be $100 or several thousand dollars. If you have a deductible, insurance will process your claim and your responsibility will be the full contracted rate for the service. For example, if we have a contract with your insurance that we will be paid $125 for a service and you have a deductible, you will be responsible for the full $125.
COPAY and COINSURANCE
Usually after you exhaust your deductible in each insurance year, you may have a copay or a coinsurance. A copay is a fixed amount you will pay each session, like $20 or $50. Insurance will cover the rest of our contracted rate.
A coinsurance is a percentage you pay for each session, like 20% or 30% of the contracted rate. For example, if our contract rate with your insurance is $125 and you have a 30% coinsurance, you would be responsible for $37.50 ($125 x .30 = $37.50). Insurance will cover the rest of our contracted rate.
Sometimes insurance begins to cover the ENTIRE cost of your services. That’s because you have reached your “out-of-pocket” maximum, which is the maximum amount you and/or your family are required to pay out-of-pocket for deductibles and copays/coinsurances each insurance year.
Please know this information is for educational purposes only and may not accurately describe how your specific insurance functions. It is the responsibility of each client of Lyn-Lake Psychotherapy and Wellness to be aware of her/his/their insurance benefits. However, we hope this is a helpful guide to some terminology that you may encounter in your research.
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We look forward to hearing from you, whether you’re requesting your first appointment, submitting your resume to be considered as either an associate or an intern, or just have a question or comment.