Why Insight Does Not Participate in Insurance Networks

Insurance can be useful, but participating in an insurance network also means agreeing to that insurer’s rules regarding covered diagnoses, medical necessity, documentation, authorization and reimbursement.

Remaining independent gives Insight greater flexibility in how care is structured and allows our clinicians to spend more of their time focused on treatment.

It also limits the amount of information routinely sent to an insurance company. When you do not submit treatment to insurance, your insurer does not receive a claim for that care.

Using Out-of-Network Benefits

Being out of network does not necessarily mean your insurance provides no coverage.

Many health plans include out-of-network behavioral health benefits. Depending on your plan, your insurer may reimburse you for part of what you paid after you meet an out-of-network deductible.

Insight does not determine how much an insurance company will reimburse, and reimbursement is not guaranteed. Coverage, deductibles, reimbursement rates and claim requirements vary significantly by plan.

Before beginning treatment, you may want to ask your insurance company about:

• Your out-of-network mental health and behavioral health benefits
• Your out-of-network deductible and how much has already been met
• The percentage your plan reimburses after the deductible
• Whether reimbursement is based on the full session charge or your insurer’s allowed amount
• Whether your plan requires prior authorization or additional documentation
• How and where to submit an out-of-network claim

What Is a Superbill?

A superbill is a detailed document you can submit to your insurance company when seeking reimbursement for out-of-network care.

Insight can provide the documentation typically requested by insurers. A superbill generally includes information such as the provider, dates of service, type of service, applicable billing codes, diagnosis information and the amount charged.

You submit the superbill directly to your insurance company. Your insurer then determines whether the service qualifies for reimbursement under your individual plan.

What Information Does Insurance Receive?

This is an important distinction between paying privately and choosing to seek insurance reimbursement.

If you submit a superbill, the information contained on that document becomes part of your insurance company’s records. This generally includes information identifying the service you received and may include diagnostic information required to process the claim.

Submitting a superbill does not automatically give your insurance company access to your complete psychotherapy notes or entire clinical record.

In some circumstances, however, an insurer may request additional information before approving reimbursement. If additional clinical information is requested from Insight, appropriate authorization is required before information is released, except where disclosure is otherwise permitted or required by law.

Once information has been submitted to an insurance company, that information is maintained according to the insurer’s own privacy and recordkeeping policies. Insight cannot control how an insurance company stores information after it has been released. This is also reflected in Insight’s current clinical agreement.

Good Faith Estimates

If you do not have health insurance or choose not to use insurance to pay for your care, you have the right to receive a Good Faith Estimate of the expected cost of scheduled services under the federal No Surprises Act.

A Good Faith Estimate is intended to give you advance information about anticipated charges. It is an estimate and may change if your treatment needs or services change.

You may request a Good Faith Estimate from Insight before receiving care.

Cancellation Policy

Insight maintains a 24-hour cancellation policy.

Appointments canceled with less than 24 hours’ notice are charged the full session fee. The charge is for a missed appointment rather than a completed clinical service and therefore generally cannot be submitted to insurance as a treatment session. Insight’s current clinical contract reflects this policy.

Your Information Is Not for Sale

Insight Into Action Therapy will never sell client data.

Information collected in connection with your care is used to provide and coordinate services, operate the practice and meet applicable clinical and legal requirements. It is not a product to be sold to advertisers, data brokers or other companies.