Insurance

We are hopeful that things can change with insurance, but currently, our specialty services do not fit within the “usual and customary” services that insurance plans cover as in-network services. Therefore, ATSA services are out-of-network. This means that full fee is collected at the time of service, and we provide you with an insurance-reimbursable statement that you submit to your insurance. This does not mean they don’t cover us at all! It means that you will use your out-of-network benefits for services at ATSA, and luckily, most health plans provide out-of-network coverage along with in-network coverage. Click here to read an explanation of in-network and out-of-network care.

We understand that treatment at ATSA is a significant investment, and we want to help you make an informed decision about your care. Knowledge is power, and we want you to feel empowered by reading through the FAQs below. 

 If you need additional help, please do not hesitate to contact us by calling 630-230-6505 or emailing intake@advancedtherapeuticsolutions.org. We are here to help!

FAQ’s

Why should I go out of network? It’s expensive, and I want to use my in-network benefits. 

Actually, the first step is to always to contact your insurance and see if there is a provider within your insurance network that can address your needs. Part of ATSA’s mission is to spread awareness and knowledge about evidence-based treatments, and we do that through our training programs. So, our hope is that we are adding more in-network providers that apply evidence-based treatments. You can find out about what providers are in your network by taking these steps:

      • Go to the website that is listed on the back of your insurance card.
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      • Select the option to find a provider (e.g., usually called “Find a Provider” or “Find a Doctor”). Follow the prompts (e.g., enter zip code, mile radius, etc.). Some websites allow you to enter what condition you are seeking treatment for (e.g., anxiety). The output should be a list of providers in your area that are also in your network.
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      • Review the list of providers and contact them for more information. Ask them questions such as: Are they taking new patients? What treatment approach do they use? Do they specifically use evidence-based treatments, and if so, which ones? How much experience do they have treating the condition you are seeking help for? 
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      • If you are having difficulty using your insurance website to find a provider, then you can call the phone number on the back of your insurance card for additional assistance. Sometimes an insurance rep is able to email you a list of providers, which may be easier for some vs. going on the website and searching for providers.
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      • Cross-reference your list with the list of in-network providers we have trained or have worked with in the past. Finding a good fit is hard, so we hope that by providing a list of providers that we have worked with in the past can help you narrow down your search.
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      • If you have severe symptoms or a condition that is not generally known or treated, it may be more cost-effective in the long run to see a specialist who can treat the condition effectively and timely, then you can step down to in-network care for maintenance of treatment gains. In-network services may be more financially convenient for you now, but if you are not making progress, then you may be extending the duration of time in treatment while not getting better. In fact, things can get worse, creating not just additional financial costs, but social-emotional costs as well. For example, if anxiety is getting in the way of a student getting through middle school, there can be significant consequences of missing important developmental milestones, additional interruptions in high school, and continued struggles in adulthood. If anxiety is getting in the way of an adult accepting a job offer or promotion, there can be significant consequences to their career trajectory and their sense of fulfillment. These are high costs to pay, especially when anxiety is treatable. So, when considering your health care options and cost, remember that out-of-network care can be short-term to help you receive the dose of treatment that you need to reach an effective result, then step down to in-network care for maintenance of your treatment gains. 

When should I consider ATSA rather than a provider who is in-network with my insurance?

    • If you have tried an in-network provider but have seen limited progress, it may be time to consider other options. 
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    • If your/your child’s symptoms are severe and “usual and customary” in-network therapy is not enough to move the needle towards recovery, intensive treatments may be warranted. 
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    • If you/your child’s progress is apparent in the clinic setting, but not transferring to other settings (e.g., school or community), then treatments outside of the clinic may be warranted.
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    • Some in-network providers may not be able to provide services outside the clinic, and won’t be reimbursed for intensive services of multiple hours per day. In-network providers are bound by contract to provide the “usual and customary” treatment, which is 45-min therapy sessions (90834) or extended sessions (60-75min; 90837), but not multiple times in one day. So the max per day they can provide is 75 min per day, and usually only with pre-authorization for the 90837 code vs the 90834 code. If they provide multiple hours in one day, insurance will only reimburse the provider for one of those hours. It appears that because in-network providers are not allowed to “balance bill” patients, they are not allowed to collect the additional uncovered cost of the other units provided on that day. There is a lot of confusion on what is allowed and what is not, but it appears that insurance considers, at most, 75 minutes is “usual and customary”, and providing exposure therapy beyond that duration may not be reimbursed, leaving the provider uncompensated.
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    • ATSA is not in network with insurance companies because of the specialty treatments we provide, including prolonged exposure therapy that go beyond what is “usual and customary.” So, to help patients maximize their health benefits, we can collaborate with your in-network therapist and provide intensive treatments or specialized treatments as an adjunct service. Out-of-network care is expensive, so our goal is to help you/your child reach an effective therapeutic dose of therapy to help you achieve recovery, and then continue with your in-network therapist for maintenance and continued treatment. By combining both in-network and out-of-network services, you are maximizing your health care options. 

What questions should I ask my insurance plan so I can be informed on what my financial responsibility will be?

Be sure to ask the following questions:

    • What is my out-of-network coverage?
        • They will tell you what percent they cover and what percent is your responsibility.
    • What is the allowable rate?
        • Their percentage that they cover will be based on their “allowable rate”, NOT on what ATSA charges. So make sure to ask what the allowable rate is. They may or may not tell you. Be insistent. If they don’t tell you, you may have to wait until you actually complete a session, submit your claim, and then you will see it on your Explanation of Benefits (EOB) that they will send in the mail with your reimbursement check. 
    • What is my deductible?
        • You will need to meet the deductible before insurance coverage begins. Make sure you submit the statements we send you so that it can be counted towards your deductible.
    • How much of my deductible is left for me to meet before insurance kicks in?
        • Deductibles start over every year. Most employer-based plans use the calendar year (Jan-Dec). A few may use the fiscal year (12 months, but not necessarily starting in Jan). Check to make sure what months your deductible runs.
    • How do I go about getting an in-network exception?
        • Insurances have a way to request an exception for coverage for out-of-network services, but keep in mind this is not information that is easily available. You may or may not find information about this option on your insurance website, and your insurance rep may or may not know how to help you with this. Ask to speak to a supervisor about obtaining an in-network exception, also called a gap exception or a single-case agreement. Click here to learn more about in-network exceptions.

It is too expensive to go out of network. Why would anyone do that? 

    • If a person needs specialty care, they may have to go out of network to receive it. In-network care is reimbursed by insurance companies within what's “usual and customary”, and specialty care goes beyond what is usual and customary. So, specialty providers may be out-of-network with insurance companies as a result. See “When should I consider ATSA rather than a provider who is in-network with my insurance?”

If I can’t find a provider within my insurance network, will my insurance make an exception?

What is an in-network exception?

    • An in-network exception (also called “single case agreement” or “gap exception”, and could have other names depending on your insurance) is when your insurance will cover services by an out-of-network provider as if they were in network. This means your reimbursement rate would fall under what is listed in the In-Network column of your health benefits information. Reimbursement for out-of-network services is less; reimbursement for in-network services is higher. So, you would receive a higher amount of reimbursement using your in-network benefits even though you are seeing an out-of-network provider. Click here to learn more about in-network exceptions.

What is the best way to submit my claims?

The best method to use is submitting it through your insurance website.

    • Go to your insurance website address (found on the back of your insurance card).
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    • Log in. If you have not created an account, you will be prompted to do so.
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    • Once logged in, find the “Claims” button. There should be an option where you can submit your own claims. Select that option.
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    • Answer the prompts that are asked, which will include name of the patient, date of service, etc. 
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    • Refer to the statement that we send you after each appointment. All the information you need to submit your claim is on that statement.
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    • If there is an option to upload a statement, select that option and upload the statement that we send you after each appointment. 
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    • Doing it this way keeps you in control of seeing that the claim has been submitted (look in the “submitted claims” section) and allows you to continue tracking it. It is typically faster to process as well, compared to mailing or faxing it in.
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    • Once processed, you should receive a check sent directly to you from your insurance company.
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What is a Flexible Spending Account (FSA) or a Health Savings Account (HSA)?

    • Definitely look into a Health Savings Account (HSA) or Flexible Spending Account (FSA) that allows you to pay for out-of-pocket health care costs with pre-tax dollars. The difference between an HSA and an FSA is that usually the HSA is employee-owned and controlled, while the FSA is owned by the employer. Note that some employers match the contributions you make to your FSA up to a certain amount, which provides another way for you to save on your overall healthcare out-of-pocket costs. If you expect to have a lot of out-of-pocket health care costs in the year, it may make sense to elect the maximum allowable contribution amount, especially if your employer will match your contribution. Contributions, usually deducted bi-monthly from your paycheck (so you don't pay taxes on the amount), and are put into a separate account. Typically, you will receive a physical debit card that you can use to pay for health care services, and the amount is pulled from your health care savings account, making the process seamless. ATS and most healthcare service providers accept payment from an FSA or HSA card. Find out what your maximum health care savings account contributions can be, and figure this into your strategic planning for the year. Remember, your company's Human Resources department can help you with this if you need more guidance. To learn more about health spending accounts, click here.

Can I use my FSA or HSA account to pay for ATSA services?

    • Absolutely! In fact, we highly recommend that you use your FSA or HSA account as the first form of payment. We run it as we would a typical credit card, and email you the statement for you to submit to your insurance for reimbursement.

 

Payment
Payment is required at the time of service. Accepted forms of payment include cash, check, or credit card (Visa, MC, DISC, AMEX, FSA, HSA).
 

Cancellation Policy 
Please provide at least 24 hours notice if you need to cancel your session(s). Please be aware that a late cancellation or missed appointment means this time cannot be offered to another patient, and you will be charged a $75 cancellation fee. To ensure we receive your cancellation request on time, cancellations are only accepted via phone. Please call 630-230-6505 (and press 0 if calling outside business hours). No cancellations can be made via email.

Contact 
We strive to provide premiere psychological services that meet your individual needs, including helping you with insurance. If you have any questions about any of our services or would like more information, please reach out to us at 630-230-6505 or at intake@advancedtherapeuticsolutions.org.

 

 

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