Insurance vs. Private Pay

Frequently Asked Questions

​

Do you take insurance? How does that work?
Yes. The M.A.D. Therapy takes a limited number of insurance plans for Iowa based clients. Clients residing in Florida are private pay only.

 

However, it is your responsibility to contact your insurance company to determine your in and out-of-network benefits. You may be provided with a superbill to submit to your insurance company for possible reimbursement. Please check and review your coverage carefully to ensure that you understand their answers. Here are some helpful questions to consider and/or ask:

 

• What are my mental health benefits, deductibles and/or co-pay?

• What is the coverage amount per therapy session and how many covered therapy sessions are covered per year?

• How much am I reimbursed if I use an out-of-network provider?

• Is approval required from my primary care physician?

• How much is my deductible and has it been met?

• Read more on Understanding your Insurance on our blog.

​

Many factors need to be considered. Before scheduling a therapy session, be sure to contact your insurance company to verify your coverage and what portion is your responsibility. Always verify that deductible! Remember they pay nothing until you have met your deductible.

​

​

Why don't you accept insurance in Florida?

​

Various reasons impact clinicians decision to accept or not accept insurance such as if insurance companies are adding more providers to their panel to clinicians personal choices to join an insurance network. At this time, The M.A.D. Therapy does not accept insurance in the state of Florida.

​

​

Many decide NOT to use their insurance plan. Why?

​

There are benefits to being private pay rather than using your insurance plan coverage.

Insurance companies require an actual diagnosis to confirm medical necessity. They need this in order to determine if they feel the services are needed and then to assist in covering. They may also request certain information (e.g., the reason for requesting services). Any of the information documented for you regarding each appointment becomes part of your personal health record. Additionally, the insurance company reserves the right to audit my files to ensure continued necessity for services. You have the right to be private pay for your services to avoid sharing your private information with your insurance company if desired.

​

​

Do I need a diagnosis?

If you plan to use your insurance, then yes, you do.

​

It is required by your insurance company in order for them to contribute to the bill. However, not everyone meets the criteria for a qualifying diagnosis and some seek services to improve certain areas of their daily life. In order to avoid having a diagnosis on your eternal electronic health records, one must be private pay.

​

Insurance company may dictate the therapists you can choose as most insurance companies have contracts with healthcare providers. These are the providers who are known as being in-network. Some insurance companies may not offer out-of-network benefits if you want to choose your own therapist. If you choose to see an out-of-network provider, insurance companies usually reimburse you at a lower rate, but only if your annual deductible has been met. Private pay can be a benefit as it ensures you find the right therapist for you.

​

​

What is covered?

That depends.

​

Many insurance companies reserve the right to limit the number of sessions they will pay for in a calendar year or the type of therapy you may participate in. Please contact your insurance to verify these coverage details. As private pay, you and your therapist will determine your course of treatment.

​

Please choose wisely after gathering all the details.

​

​

What is a Good Faith Estimate?

A formal document to meet the requirements of the No Surprise Act (H.R. 133), which is only applicable to private pay clients at this time.

​

YOU HAVE THE RIGHT TO RECEIVE A “GOOD FAITH ESTIMATE” EXPLAINING HOW MUCH YOUR MEDICAL CARE WILL COST.

Under the law, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. 

​

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

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. 

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

• Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1 (800) 633-4227.