Why We Built the Insurance Reimbursement Calculator
January 9, 2023
In the first post about Nirvana’s products, we discuss our software design philosophy and introduce the first major element of our platform, the Out of Network Reimbursement Calculator Read on to learn why we built it and how it works.
By Kelvin Chan, President & Chief Product Officer
It’s a mundane task you’ve done repeatedly: buying groceries with a credit card. When you swipe your card, myriad systems come into play. They check whether you have enough credit, ensure the transaction isn’t fraudulent, process your payment, and more. You never encounter them, so you forget that these systems exist. But the simple is rarely as straightforward as it seems.
Mental health billing lacks that simplicity. The systems that were so unobtrusive when you used your credit card are front and center when you use insurance. Claims filing. Prior authorizations. Long hold times with your health plan. A new vocabulary filled with jargon: deductible, coinsurance, stop loss. No other consumer industry expects as much from its customers.
At Nirvana, we build products to make mental health billing as simple as buying groceries so that more people can affordably access care. The reason is that finding a therapist is already overwhelming.
For example, most therapists who accept insurance are booked solid. Many others don’t take insurance because it is difficult to manage and reimburses poorly. For a client, paying for therapy with an out-of-network benefit is slow, manual, and cumbersome. The financial anxiety of not knowing what your health plan covers is a barrier to care.
This is not how it should work. Seeking mental healthcare shouldn’t mean spending hours on hold with an insurer, painstakingly filling out claim forms, or juggling Superbills. Logistics shouldn’t prevent clients from obtaining care.
Nirvana built the Insurance Reimbursement Calculator because we believe in price transparency for mental health billing.
Price transparency is one of the main principles of Nirvana’s product philosophy. It should be easy and free for a client to determine which therapist they can see and to understand exactly how much they will be reimbursed.
This visibility helps clients and therapists alike. While clients can attend therapy without worrying about cost, therapists can grow their practices from a pool of clients who would otherwise have been excluded. Everybody wins.
To address the lack of price transparency in mental health billing, Nirvana built the Out of Network Coverage Calculator.
What is the Out of Network Insurance Coverage Calculator and how does It work?
The Nirvana Out of Network Reimbursement Calculator is a free tool that 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 do so, one only needs to enter details like a client’s name, date of birth, therapist, and insurance plan.
Behind the scenes, the Calculator obtains information from web services that connect to the client’s insurer. It then presents a coverage estimate, broken down into three phases:
- Phase 1 – Reimbursement per session for the start of the plan year, usually when the deductible has not yet been met.
- Phase 2 – Reimbursement per session for after the deductible has been met, usually based on the insurer’s allowed amount.
- Phase 3 – Reimbursement per session for after the out-of-pocket maximum has been reached, when a plan may reimburse the total cost of the session.
Customizing the Calculator for a better client experience
You can use the Out of Network Insurance Coverage Calculator for free, as can your clients. However, if you have a website, you can build a better experience by embedding the Calculator on it and tailoring the settings so that your own therapists and session types are displayed.
Customizing the calculator is also free, because it fits Nirvana’s overarching goal of making mental healthcare available to all Americans and increasing transparency around mental health insurance. For more information on customizing the Calculator, contact us at firstname.lastname@example.org.
More product posts are on the way
The Out of Network Reimbursement Calculator is only one component of Nirvana’s platform, just as price transparency is a single part of our product philosophy. The Calculator seamlessly integrates with Concierge, a therapist-oriented mental health billing platform that automates the claims filing process. Nirvana also offers Client Portal, a client-facing view that supplements Concierge.
Both Concierge and the Client Portal support the second major element of our product design philosophy: claims automation. Stay tuned for posts about these products and how we are reinventing the archaic claims system in healthcare.