At KDH Counseling, we understand that navigating insurance can be overwhelming. That’s why we aim to make the process as smooth and transparent as possible. Below is a step-by-step guide to how we process insurance claims for mental health services, along with important information about your financial responsibilities as a client.
How We Process Mental Health Claims for Insurance
Step 1: Collecting Your Insurance Information
Before your first appointment, we’ll ask you to provide your current insurance information in the patient portal, including the front and back of your card and your date of birth. This allows us to verify your benefits and eligibility.
Step 2: Verifying Benefits
While we may verify your coverage as a courtesy, it is ultimately your responsibility to understand your insurance plan. This includes knowing your deductible, copay, coinsurance, number of sessions allowed, and whether you need prior authorization. We recommend calling your insurance company and asking these questions so that you are informed with the most up-to-date information about your benefits.
Step 3: Collecting Payment at Time of Service
We collect payment at the time of services based on what we discover when we verify benefits. We do this to help you avoid stress from unexpected bills due to deductibles or coinsurance. Communication regarding billing is handled via text message to ensure a written record of what is shared. If you have questions, you can contact our billing department directly at 337-349-5431. We collect payment on the day of services through the card that is submitted in the patient HIPPA compliant portal unless client sets up another type of payment through the billing department.
Step 4: Submitting Claims
After each session, we submit claims electronically to your insurance provider using the diagnostic and procedural codes relevant to your treatment. This is typically done within a few business days of your appointment and may take a few weeks to process.
Step 5: Insurance Processing
Once submitted, your insurance company processes the claim and determines how much they will pay based on your plan. They send an Explanation of Benefits (EOB) to both you and our office—usually we receive it first.
Step 6: Applying Payments and Balances
If insurance covers part of the session, they will reimburse our office and indicate any remaining balance due. We will bill you for any unpaid amount, which may include a copay, coinsurance, deductible, or non-covered services.
Step 7: Client Billing
We will text you to inform you of any balance due and collect payment at that time or help you set up a payment plan. We accept various forms of payment and offer online billing for your convenience. Prompt payment is appreciated to avoid disruption of services.
Step 8: When Cards on File Are Declined
Many clients receive new cards, update security settings, or block charges, which can result in declined payments. Because payment is due on the day of service, we require any declined balance to be paid prior to your next session. If payment is not made, adult client sessions will be paused until the balance is resolved.
If a client stops services with a balance due, we will make reasonable efforts to collect payment. The billing department will first send a text reminder, followed by a mailed bill if no response is received. If a balance remains unpaid after 90 days, we will forward the account to a professional collections agency.
Important Disclaimer: Client Financial Responsibility
We are happy to assist with the submission of insurance claims on your behalf. However, you are ultimately responsible for all fees associated with your care, regardless of insurance coverage.
This includes situations such as:
Denied claims
Out-of-network charges
Services not covered by your plan
Deductibles, coinsurance, or copays not yet met
If your insurance provider does not pay for any reason, you are responsible for the full cost of services rendered.
We encourage all clients to:
Confirm coverage details with your insurance provider
Ask whether mental health services are covered
Verify if pre-authorization is required
Check if we are in-network with your plan
By beginning services with us, you agree to these terms of financial responsibility.
Private Pay
We collect payment at the time of service through our secure patient portal. If you prefer another payment method, please contact our billing department to make arrangements.
24-hour Cancelation Policy
We require 24 hours' notice for any appointment cancellations. If you do not provide this notice, you will be charged the full session fee. While payment plans can be arranged for missed appointment fees, the best way to avoid this charge is to cancel or reschedule your appointment at least 24 hours in advance.
Questions?
We’re here to help. If you have any questions about the billing process or insurance claims, please don’t hesitate to contact our office at 337-349-5431 or kd@kdholmeslpc.com.
