• Allowed amount: The amount your insurance will recognize as acceptable for Mental Health Office/Telehealth Visits. We charge $250 per session (for a standard individual therapy session), however, each insurance determines how much of our fee they are willing to pay. That is the “allowed amount”. For most In-Network insurances, it is a flat fee, that has been previously negotiated based on our contract and for Out-of-Network will know this rate after your claim has been processed. 

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• Patient Responsibility: Amount that you're responsible for your session. If you're In-Network this amount is based on your benefits (*). If you're Out-of-Network is based of the amount provided on your onboarding. If you have any questions related to patient responsibility or explanation of benefits please email: support@jamroncounseling.com. If you have any owed amount our billing dpt. will be in contact with you via email. 

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• Deductible: Many plans have a deductible amount, which refers to the out of pocket amount that the patient will need to pay before the insurance will be responsible to make any payment of their own. This amount varies greatly between insurances. After you have met your deductible amount, you will sometimes have a Co-pay or Co-insurance amount due that will be your new patient responsibility. 

 

• Co-pay - Co-Insurance : Once you meet your deductible you may have a flat fee that you must pay pay per visit called a Co-pay. Or you could have a Co-insurance, a percentage of the total fee or “allowed amount” that you must pay per visit.

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• Effective Date: Date that your insurance become active. 

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• Plan Date: Date that your insurance cycle resets. This could mean that your deductible will reset and your benefits might change. It's good to contact your insurance when your plan resets to know if there are any changes in your benefits.  

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• Primary Insurance: Insurance that will be responsible for making the payments for the visits. Be sure to not be listed under another insurance (previous job, partner, family, etc.) and if you have another insurance listed please provide us the information to determine which insurance will be responsible to make the payments. 

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• Out of pocket Maximum: If you have many medical expenses over the year you may reach your out-of-pocket maximum, if your policy has one. Once you reach your out of pocket maximum this would mean that your insurance company covers 100% of the costs for your visits from that point on, until the new policy year begins.

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• Claim processing: Claim processing takes up to 45 calendar days. We submit claims at the end of the month for tracking purposes. We advised if your insurance change please inform support@jamroncounseling.com about this to avoid gaps in coverage and accumulation of owed amounts. 

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• Supervisory Billing: If you're seeing a therapists who is under supervision (Mental Health Counselor with Limited Permit or an Intern) the name of their supervisor (LMHC, LCAT) will appear on your Explanation of Benefits. 

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(*) Disclaimer: Please note that a coverage determination, prior authorization, or certification that is made prior to a service being performed is not a promise to pay for the service at any particular rate or amount. The patient's summary plan description governs amount payable, as every claim submitted is subject to all plan provisions, including, but not limited to, eligibility requirements, exclusions, limitations, and applicable state mandates.