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Reducing Costs

As a provider of healthcare services, we specialize in working with health insurance to reduce the costs of our services. Our dedicated billing specialist handles the insurance billing process, so you can focus on treatment. We will happily assist with determining if our practice and the provider are in-network with your insurance plan. We do not want you to pay for something that is reimbursable through your insurance plan. Insurance companies will typically provide full or partial payment of the costs for medically necessary services. In-Network and Out-of-Network benefits will vary based on the insurance plan.​

Our billing specialist will handle all of your insurance needs including:

  • Verifying your insurance benefits before starting services

  • Provide an estimated cost for services

  • Handle all referral and prior authorization requirements from your insurance company

  • Directly bill your insurance plan to receive reimbursement directly from the insurance company

  • Provide you with monthly statements for record keeping

  • Contact your insurance company to deal with any issues related to claims processing or payments

Please contact our office to speak with our billing specialist for additional questions and information.

Health Insurance

Participating In-Network provider with the following insurance plans

  • Aetna

  • Carelon Behavioral Health

  • Cigna (EverNorth)

  • Johns Hopkins EHP

  • Johns Hopkins USFHP

  • Kaiser Permanente of the Mid Atlantic

  • Medicare

  • Sana

  • Quest Behavioral Health

  • United Healthcare - Optum - Oscar - Oxford - UMR

  • BlueCross BlueShield (BCBS)

  • All BCBS regional plans, specifically including:

    • CareFirst

    • Anthem BlueCross BlueShield

    • Blue Cross Blue Shield of Massachusetts

    • Anthem Blue Cross and Blue Shield New York

    • Anthem Blue Cross and Blue Shield Colorado

    • Blue Cross and Blue Shield of Alabama

    • Horizon Blue Cross and Blue Shield of New Jersey

  • Anthem EAP - Bank of America

  • Medicare Advantage plans:

    • ​Horizon Blue Cross and Blue Shield of NJ Medicare Advantage

    • Kaiser Permanente of the Mid Atlantic Medicare Advantage

    • ​United Healthcare Medicare Advantage

Out-of-Network Insurance Information

​For other health insurance plans not listed above as in-network, our practice is likely considered an Out-of-Network provider. We understand navigating insurance and billing can be complex, and we are here to help. Typically, plans with Out-of-Network benefits will cover a majority of the costs and in some instances the benefits will cover the entire costs for services. Our practice has resources in place to manage the billing process for out-of-network benefits, making the experience as seamless as possible for you. If you have any questions about out-of-network coverage or need assistance understanding your benefits, our team is happy to provide support and guidance.

Self-Pay Services

For Self-Pay services, our session rates vary based on the services being provided. Our practice always offers an initial free phone consultation to understand your needs and determine the best options for your care. We encourage you to contact our office to review and receive an estimated cost range. We are committed to transparency and we complete a Good Faith Estimate form prior to the start of care. Your understanding and confidence in the financial aspects of your treatment are important to us, and our team is available to answer any questions you may have.

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Learn more about Good Faith Estimates for services not covered by in-network health insurance.

Understanding Health Insurance Benefits

At our practice, we believe that understanding health insurance is an important step in managing your healthcare experience. Navigating health insurance plans and benefits can sometimes feel overwhelming, especially for those who are new to it. But understanding the basics of how health insurance works can empower you to make better decisions about your healthcare and finances. Below, we’ve outlined some key terms and concepts to help better understand how health insurance benefits work and important concepts like premiums, deductibles, co-pays, coinsurance, and out-of-pocket maximums.

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What is Health Insurance?
Health insurance is a contract between you and an insurance company. It helps cover part of the costs for medical care, from routine check-ups to unexpected hospital stays. You pay a certain amount (your premiums) to the insurance company, and in return, they provide benefits to help cover your medical expenses. However, you'll often share some of the costs, and how much you pay depends on your specific plan.

Key Terms and How They Impact Your Costs

To better understand how health insurance works, it’s important to familiarize yourself with some essential terms. These terms directly affect how much you pay for healthcare and how your insurance benefits are applied.

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Co-Pays

A co-pay is a fixed amount that you pay out of pocket for certain healthcare services. For example, you might be required to pay $20 every time you visit your primary care doctor. Co-pays are typically due at the time of the appointment and are determined by your health insurance plan. They are generally predictable and do not vary based on the total cost of the service you are receiving.
 

​Deductibles
A deductible is the amount you must pay out of pocket for healthcare services before your insurance starts to share the cost. Not all services require you to meet your deductible first. For example, some plans cover preventive care, like annual check-ups, without requiring that you meet your deductible. Once the deductible is met, you generally shift to paying a percentage of the costs (that’s where coinsurance comes in). ​​Once you’ve met the deductible for the year, your insurance will begin covering a portion of the costs for additional services.

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Coinsurance
Coinsurance is the percentage of the cost of a healthcare service that you are responsible for paying. Unlike a co-pay, which is a fixed amount, coinsurance is based on a percentage of the total cost for the services. The specific percentage is determined by your insurance plan. For instance, you might pay 20% while your insurance covers the remaining 80%. 
 

​Out-of-Pocket Maximum
The out-of-pocket maximum is the most you’ll have to pay within a plan year for covered services. Once you reach this limit, your insurance covers 100% of covered services for the rest of the year. This includes your deductible, coinsurance, and co-pays but does not include your premium.

 

How Are Costs Determined?
Several factors contribute to the costs associated with your health insurance. Here’s a breakdown of what influences your expenses:

  • Type of Plan: Health insurance plans are categorized in tiers (e.g., Bronze, Silver, Gold, Platinum). Bronze plans usually have lower premiums but higher out-of-pocket costs, while Platinum plans have higher premiums but lower out-of-pocket costs.

  • Network: Insurance companies often have a network of preferred providers (doctors, specialists, behavioral health, hospitals, etc.) that have agreed to offer services at negotiated rates. Visits to out-of-network providers usually result in higher costs or may not be covered at all.

  • Covered Services: Each plan has a list of covered services.

  • Preventive Services: Following the Affordable Care Act (ACA), most plans cover preventive services, such as screenings and immunizations, at no cost to you.

  • Usage: Your overall healthcare costs will naturally depend on how often you visit the doctor, require medications, or need procedures.

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​Tips to Make Health Insurance Work for You

​Understanding these basic principles of health insurance can help you better manage your care and spending. Here are a few tips to make the most of your benefits:

  • Review Your Plan Details: Familiarize yourself with your plan’s deductible, co-pays, and coinsurance before scheduling treatments.

  • Stay in Network: Whenever possible, use in-network providers to save on costs.

  • Ask Questions: Don’t hesitate to contact your insurance provider or healthcare practice for clarifications about your benefits and coverage.​​​

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