Billing and Insurance FAQ’s

A: It is the responsibility of each client to contact their insurance company directly or refer to their benefits booklet to verify their coverage prior to their first appointment. This includes confirming any fees due at the time of service, deductibles, and any required authorizations. Please note that we cannot guarantee that your insurance benefits will cover behavioral health services.

Please be aware that it is your responsibility to stay informed about your insurance benefit coverage, including any exclusions, deductibles, copay, and coinsurance amounts. Any amounts not covered by your insurance are the client's responsibility. Clients will be held financially responsible for services provided should their insurance benefits fail to cover services.

Changes in Insurance If your insurance changes at any point, it is your responsibility to verify your new benefits and notify Wild Heart Society of the change before your next scheduled appointment.

Secondary Insurance If you have a secondary insurance plan that you would like billed, you will need to confirm with your insurance companies which is the primary and which is the secondary, and provide Wild Heart Society with all relevant information for both plans.

A: A deductible is the amount you are required to pay out of pocket for healthcare services before your insurance begins to cover costs. For example, if your deductible is $1,000, you will need to pay that amount toward covered services before your insurance starts paying its share.

While your deductible is being met, you will be responsible for the cost of our contracted rate with your insurance company. Please note that this rate varies from company to company.

If Wild Heart Society is aware that you have a deductible that needs to be met, we will not charge your payment method on file until the Explanation of Benefits (EOB) has been received at our office.

If you have questions about your deductible or our contracted rates, please don't hesitate to reach out:

• Potential Clients – Contact us at info@wildheartsociety.org

• Current Clients – Reach out to your therapist directly

A: A copayment (or copay) is a fixed amount you pay for a covered healthcare service, regardless of the total cost of the service. For example, if your copay is $30, you will pay that amount at the time of your appointment while your insurance covers the rest.

At Wild Heart Society, our clinicians check clients in within 24 hours of their appointment taking place, at which time your copay will be processed using your payment method on file. Please note that it is your responsibility to be aware of whether you have a copay, coinsurance, or deductible and the amounts associated with each. We recommend verifying this information with your insurance company prior to your first appointment.

A: Coinsurance is the percentage of the cost of a covered healthcare service that you are responsible for paying after your deductible has been met. For example, if your coinsurance is 20%, your insurance will cover 80% of the cost and you will be responsible for the remaining 20%.

At Wild Heart Society, coinsurance is handled the same way as a copayment — our clinicians check clients in within 24 hours of their appointment taking place, at which time your coinsurance will be processed using your payment method on file. Please note that your coinsurance amount is based on our contracted rate with your insurance company, which may vary from provider to provider.

A: As a courtesy, we bill your insurance carrier directly. However, please note that billing your insurance does not guarantee that your services will be covered, and it is your responsibility to provide accurate insurance coverage information, including your copay and coinsurance amounts.

Insurance claim return times vary from provider to provider. Unless you carry a Medicaid plan, you may be held financially responsible for the cost of services should your insurance fail to cover them.

Please be aware that it is your responsibility to stay informed about your insurance benefit coverage, including any exclusions, deductibles, copay, and coinsurance amounts. Any amounts not covered by your insurance are the client's responsibility.

Changes in Insurance If your insurance changes at any point, it is your responsibility to verify your new benefits and notify Wild Heart Society of the change before your next scheduled appointment.

Secondary Insurance If you have a secondary insurance plan that you would like billed, you will need to confirm with your insurance companies which is the primary and which is the secondary, and provide Wild Heart Society with all relevant information for both plans.

A: An Explanation of Benefits (EOB) is a document sent by your insurance company after a claim has been processed. It outlines what services were billed, what your insurance covered, and what amount if any you may owe. Please note that an EOB is not a bill, but rather a summary of how your claim was handled.

Wild Heart Society does not provide EOBs to clients. If you need a copy of your EOB, you can obtain it directly from your insurance company, typically through their website, member portal, or by calling the number on the back of your insurance card.

A: If your insurance denies a claim, it typically falls under one of three reasons:

• Billing Error – Our admin team may have billed incorrectly. We are human and mistakes can happen! If this is the case, we will work to correct and resubmit the claim on your behalf.

• Insurance No Longer Active – Your insurance coverage may have lapsed or changed. If this occurs, it is your responsibility to provide updated insurance information. Please remember to notify Wild Heart Society of any insurance changes before your next scheduled appointment.

• Service Not Covered – Your insurance plan may not cover the services rendered. In this case, you will be held financially responsible for the cost of the session, unless you carry a Medicaid plan.

If you have questions about a denied claim, please reach out to your therapist directly.