Insurance & Rates

Modern Mental Health accepts Anthem BCBS insurance for most providers. For associate-level providers or trainees, we are unable to accept Anthem insurance for therapy. For those using Anthem insurance, you will be provided a discounted rate for services based on the contracted rates we have established with Anthem BCBS. These rates are not negotiable. Your provider cannot legally waive any patient responsibilities, including your copay, co-insurance, or deductibles, as this is considered insurance fraud.

Modern Mental Health accepts the Purdue Student & Grad Staff Insurance (UHCSR) for all providers. For those with this insurance, you will receive a discounted rate for services based on the contracted rates we have established with UHCSR. These rates are not negotiable. Your provider cannot legally waive any patient responsibilities, including your copay, co-insurance, or deductible, as this is considered insurance fraud.

We are not in network with any other commercial insurance company or with any Medicare or Medicaid plans, even if they are managed by Anthem. For those who are self-pay or do not have Anthem BCBS insurance, you will be provided a Good Faith Estimate regarding expected charges.

If you have significant financial hardship, you may qualify for a sliding scale/reduced fee for services. Approval for rate reduction requires the completion of our sliding scale application form.

Rates

The following rates are the full rates for each service provided. If you have Anthem BCBS insurance, your fees will be lower, based on our contract with Anthem and your insurance plan/coverage. If you have out of network insurance, you *may* have out of network benefits to utilize and may have a portion of these costs reimbursed to you.

For Psychological Testing services, the rates listed are per unit or per increment of time. The total cost will be based on total time required for testing. An overview or estimate of costs can be provided to you upon request or will be included in your Good Faith Estimate.

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Benefits of Using Insurance

The benefits of using your health insurance are largely financial. Typically, costs are lower than the out-of-pocket cost.

Risks of Using Insurance

Submitting a mental health or physical health claim to insurance carries a certain amount of risk to confidentiality, privacy, or to future capacity to obtain employment, military affiliation, health insurance, disability insurance, or life insurance. In some cases, insurance companies may share information with a national medical information database. For example, your health insurance record may prevent employment with organizations that require high level security clearance (such as federal employment, law enforcement, or military). Individuals may also encounter higher premiums or exclusions in their insurance plans depending on diagnoses rendered. A diagnosis must be provided for insurance claims.

This information is meant to be transparent, not to discourage seeking out mental health treatment. Please speak to your provider directly if this is a concern.

Insurance, Briefly Explained

There are a lot of nuances to understanding insurance, so here is an overview of how MMH utilizes insurance. 

  • All clients are asked to provide their insurance information

  • Ideally, MMH will verify benefits as a courtesy if a patient has Anthem BCBS insurance. However, there is no way to be 100% certain what is covered under an insurance plan. We attempt to verify benefits ahead of your first appointment, but this is not always possible. Note that we are unable to verify benefits for any insurance companies we are not in network with.

  • After a client is seen at MMH, we will file a claim with your insurance if you have Anthem BCBS insurance or some out of network insurances. For other out of network insurances, we are unable to file a claim directly and instead will provide you with the documentation you need to obtain possible reimbursement. If you have an out-of-network insurance, the full fee is due at the time of service, and we will indicate that any reimbursement should be sent directly to you.

  • Anthem insurance claims typically get processed within 1-3 weeks of an appointment, but in some cases it takes longer.

  • After a claim is processed, MMH receives an Explanation of Benefits (EOB), which is a detailed account of what was billed to your insurance, what your insurance is paying, and what you owe. 

  • When the EOB is received, the credit card on file will be charged for the amount that your insurance indicated is "patient responsibility."

Insurance Vocabulary

  • Deductible: The amount of money someone must pay out-of-pocket before coverage kicks in. Deductibles are usually set at rounded amounts (such as $1000, $2000). Typically, the lower the premium someone pays, the higher the deductible they have. Deductibles will reset annually. Many plans reset on January 1st, but depending on the employer, they may reset at a different point in the year. When someone's deductible resets, they are generally responsible to pay the contracted rate toward their services until their deductible is met again.

  • Co-Insurance: This is usually a set percentage of the total bill and is the amount of money someone owes after they hit their deductible. If a policy has a 10% co-insurance, the patient will pay 10% of the total allowable charges and the insurance company will pay 90%.

  • Co-Pay: The amount a patient must pay each date of service. This amount is usually standard across a plan (i.e. the patient pays a $20 copay each visit, regardless of what service was performed). Oftentimes, someone who has a copay will have that amount regardless of whether there is a deductible. However, sometimes someone must meet their deductible in full before their copay amount applies. It varies from plan to plan.

  • Out-of-Pocket Maximum: The maximum amount of money someone will pay toward deductibles, co-insurance, and co-pays for a plan year. After the out-of-pocket max is reached, the insurance company will pay 100% of allowable charges for the remainder of the plan year.

  • In-Network: A provider is considered in-network when they have contracted with a particular insurance company and agreed to the insurance company's rates. MMH is in-network with Anthem BCBS plans only at this time.

  • Out-of-Network: A provider is considered out-of-network when they have not contracted with an insurance company. OON providers are not bound to an insurance rate and can collect the full fee for service. Sometimes people will have OON benefits and can be reimbursed for their healthcare costs, but other times they cannot.

  • Dual Coverage: This occurs when a patient has more than one health insurance plan, with one being considered "primary" and the other being considered "secondary."

  • Coordination of Benefits: This process is something that individuals with dual coverage need to do. The insured needs to contact their insurance plans and conduct a coordination of benefits to determine which insurance plan is primary and which is secondary, as well as make sure that both plans are aware of the arrangement and can process claims together.

  • Commercial Plans: Commercial plans are ones that someone typically obtains through an employer or another method of buying into their own insurance. This is different from governmental plans such as Medicaid or Medicare, even if those plans are managed by a commercial provider. For example, while we are in network for Anthem plans, we are NOT in network for Anthem-managed Medicaid plans and cannot accept this non-commercial insurance.

  • Recoupment: Also known as a clawback. This occurs when an insurance company has paid for a service but later determines that they should not have paid and/or it was not a covered service. This can also happen if the insurance company audits records or requests additional documentation and it is determined that a service was not medically necessary.

  • Superbill: This is a detailed invoice containing all necessary information for an out-of-network claim to be submitted by a patient to their insurance company in order to receive a reimbursement from their insurance plan.

Good Faith Estimate

Under the No Surprises Act (H.R. 133 - effective January 1, 2022), health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. 

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes (under the law/when applicable) related costs like medical tests, prescription drugs, equipment, and hospital fees.

  • The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill. 

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

  • You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. 

  • You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. 

  • There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on the Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. 

 

Your health care provider should give you a Good Faith Estimate within the following timeframes:

  • If the service is scheduled at least three business days before the appointment date, no later than one business day after the date of scheduling;

  • If the service is scheduled at least 10 business days before the appointment date, no later than three business days after the date of scheduling; or

  • If the uninsured or self-pay patient requests a good faith estimate (without scheduling the service), no later than three business days after the date of the request. A new good faith estimate must be provided, within the specified timeframes if the patient reschedules the requested item or service.

Note: A Good Faith Estimate is for your awareness only. It is not a contract for services.

To learn more about Good Faith Estimates, visit www.cms.gov/nosurprises or call 800-985-3059.