Nirvana Health Makes Insurance Checks Simple
April 19, 2023
Each year 141 Million (56%) of Americans seek treatment for themselves or loved ones. The cost of mental health care is a significant, yet often overlooked, contributor to peoples’ medical debt even for those lucky enough to have an insurance plan that covers a portion of mental health care. Nirvana is dedicated to creating a world where all people can seek care regardless of how much they have in their wallet. Our mission is to help clients receive the care they need without fear and uncertainty.
What is a behavioral health insurance coverage check?
The majority of potential clients are unsure of their insurance coverage, putting the exhaustive administrative burden of verifying each patient’s unique insurance coverage on the therapist. In order to understand the specific requirements of a client’s insurance a therapist must perform an insurance coverage check to confirm:
- If the client’s insurance includes behavior health benefits and if so, under what conditions. E.g., some plans only cover behavioral health services in specific scenarios and treatment cases, or they only pay for in-network providers and do not include coverage for out-of-network therapists, etc.
- If the insurance requires a deductible to be met in order for the clients to start receiving reimbursements for out-of-network coverage or for the insurance company to start paying directly for those with in-network coverage.
Why is doing one manually so confusing?
In order to manually verify a client’s insurance, a therapist may spend hours on hold with an insurer to confirm a single client’s benefits. Then they need to painstakingly fill out confusing claims forms while tracking the various superbills that need to be paid. After the claims have been submitted, insurers may take months to confirm whether or not they accept the claim. If the claim is rejected, the whole frustrating process starts again and a therapist can quickly find themselves spending hours on laborious inefficient administrative work.
What makes this process even more challenging is that there are any number of reasons that a claim can be rejected:
- Lack of guidance from the insurance company on the information they need
- Excessive use of confusing terminology in insurer’s forms making it hard to submit the claims correctly.
- Deductible requirements, or the required max-out-pocket restriction, haven’t been met.
- The client's information that you have doesn’t match the insurance company’s files.
- Your specific services are not covered by the insurance after all.
The list goes on and on.
How to interpret the results of an insurance coverage check
When checking a client’s insurance coverage, you will need to ask for the Summary of Benefits and Coverage (SBC) from the insurer.The SBC is a high level overview of a clients’ health plan’s costs, benefits, and covered health care services. The document will have three columns typically: Important Questions, Answers, Why This Matters. You can navigate these columns to confirm if your services are covered, and if so, what requirements must be met before the co-pay or co-insurance benefit begins.
It is also important to confirm with the insurance company if a client’s benefits and coverage are subject to change during the benefit year. While this isn’t very common, it is common for benefits to be adjusted at the start of a new benefit year. So if you are checking insurance coverage manually, you will want to confirm this detail to ensure that there isn’t a disruption in the client’s coverage. Insurers must give 60 days notice before any changes are made to an offered plan.
How does Nirvana make this process simpler?
Mental healthcare shouldn’t mean that therapists have to navigate confusing SBC tables and spend as much, if not more time, on the phone with insurance companies than helping their clients. No one goes into therapy to become an expert on insurance benefits.
We make checking your mental health benefits simple, clean, and easy. Once you enter your basic information, Nirvana takes over.
We also offer unlimited technical support so whether you need help with insurance reimbursements, confirming a client's out-of-network benefits, or want to know how to get the most out of insurance benefits, Nirvana is here for you.
How does Nirvana make this possible?
At Nirvana, we build products to make the mental healthcare billing process foolproof. We use cutting edge AI and machine learning to create the tools providers and administrators need to streamline their back office work and maximize insurance benefits so people can easily access pricing information on care.
For example, we automatically validate a payer and can even predict copays through our unique API. This enables us to create tools like the Calculator, which estimates how much your clients can expect to be reimbursed for therapy once their deductible has been met and their out-of-network benefits have been activated. To get started all you need to do is enter a client’s name, date of birth, therapist, and insurance plan- Try it out!
Nirvana is revolutionizing the way independent therapists and large provider groups run their practices. We help mental health professionals master the business of therapy, grow a sustainable practice, and make mental healthcare more accessible for all. To learn more about how Nirvana can help your practice or provider group click here to schedule a free consultation.