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Your insurance coverage may be different for behavioral health than what you may be used to for medical expenses. We recommend that you check with your insurance provider about coverage before your initial session, as you are financially responsible for anything that is not covered. You can contact your health insurance provider by calling the phone number listed on the back of your insurance card. A representative will be able to explain in detail what your policy covers.

BCBS

Some, not all, of our clinicians belong to the Blue Cross/Blue Shield of Illinois (BCBS-IL) Participating Provider Organization (PPO). Before your first session, we recommend that you check with your insurance provider about coverage for behavioral health services.

In some cases, your behavioral health benefits may be covered by a third-party vendor. This means that while your medical benefits may be covered under BCBS PPO, your behavioral health benefits may be covered by another provider (i.e. United Behavioral Health, Magellan, Compsych, etc.) and would be considered out-of-network.

If you find out your behavioral health benefits are covered by another provider, you can still receive services at The Family Institute. You would pay The Family Institute for services directly and we can either submit a claim to your health insurance and request they reimburse you based on the specifics of your coverage or provide you with the necessary documentation so that you can submit to your insurance yourself.

Medicare

Some, not all, of our clinicians accept Medicare. If you would like to use your Medicare insurance, be sure to make an appointment with a clinician who accepts Medicare. If you are employed and use insurance through your employer, Medicare will be secondary to your primary. We recommend checking with your human resources department to confirm coverage order.

Even though you would pay The Family Institute for services directly and in full, we can submit a claim to your health insurance (Aetna, United Healthcare, Cigna, BCBS PPO (self-pay clinicians only) and request they reimburse you based on the specifics of your coverage or we can provide you with the necessary documentation you can submit to your insurance yourself (all other health insurance plans).

Questions to Ask Your Insurance Provider
  1. Are mental health benefits covered under my plan? 
  2. Does your company manage my family's mental health benefits or is another company "subcontracted" or "carved out" to manage my mental health benefits? 
  3. Do I need pre-approval from my insurance company before I can see a mental health professional? 
  4. Do I need a referral from my primary care physician to see a mental health professional? 
  5. Do I have a deductible for services? 
  6. Are there co-payments for services? 
  7. Can I only see providers on the list provided by my insurance (in-network) or can I choose to see any qualified professional (out-of-network)? 
  8. If services are covered for providers who are out-of-network, are those services covered differently than services provided by in-network providers? 
  9. Are there visit limits, dollar limits or other coverage limits for my mental health benefits?

Referrals

Behavioral health benefits are different than those you use to see your primary care doctor or have lab tests. If your insurance does require a referral, the number of sessions will be included in the referral and we will enter this information into your file. Please keep track of this since if you and your therapist determine some additional sessions are needed, you will need to request another referral to cover them.

Claims

To have your claims submitted electronically, please fill out the Request for Electronic Claim Submission form, and bring it to your first session. Federal privacy healthcare laws prohibit your employer from obtaining any information about your participation in therapy without your written consent.

Glossary of Terms
Deductible

The amount you must pay before your health insurance company starts to pay for care, for example, $500 per individual or $1,500 per family. In most cases, a new deductible must be satisfied each calendar year. 

Co-payment

A fixed dollar amount designated by your insurance company that is your responsibility to pay at each visit (also known as "co-pay"). Common co-payment rates are $10 or $20 per visit, but be aware that copayment rates vary from insurance plan to insurance plan. Co-insurance – The part of your bill, in addition to a co-pay, that you must pay. 

Co-insurance is usually a percentage of the total bill, for example, 20%.

In-network

The therapist has a contract with the health insurance company to provide you with care and will submit your bill directly to the health insurance company for payment. However, you may be responsible for a copayment, deductible and/or co-insurance according to your health insurance company benefit plan.

Non-covered charges

Costs for therapy that your health insurance company does not pay. We recommend that you contact your insurance company prior to treatment to determine if your care is covered by your health insurance policy.

Out-of-network

The therapist is not contracted with the health insurance company to provide you with treatment. You are responsible for the payment of the care.