Category:
Insurance
The following will influence if and how much you may have to pay when using your insurance:
- Negotiated rates: Insurance companies have a negotiated rates with Dr. Swinton (as they do with all providers). These rates vary depending on the insurer and the type of service provided (e.g. intake session, individual follow-up session, couple or family session follow-up, session evaluations). These rates may be more or less than his self-pay rates.
- Insurance with a deductible: If you have an annual deductible that deductible will need to be met before insurance will contribute to the cost of your treatment. For example, if you have a $2,000 deductible you will need to have paid $2,000 in covered healthcare expenses during your current deductible year before your insurance will contribute. You are responsible for the cost until then. All payments made for counseling services will be applied to your annual deductible. The deductible resets each year. You will always get the negotiated insurance rates for services regardless of if you have met your annual deductible or not. Once your deductible has been met you will be responsible for coinsurance payment. Coinsurance is the percentage you will pay of the services rendered. A common coinsurance breakdown is 80/20, meaning insurance will pay 80% of the costs after the deductible is met and you will be responsible for 20% of the cost. The percentage you are responsible for typically ranges from 0% – 30%. You can reach out to your insurance provider to identify your coinsurance rate.
- Insurance with a defined copay: Some insurance plans have a set copay. This rate will be the same regardless of what kind of treatment is provided. Typical copays range from $15 – $60 per session. Insurance will pay all other costs beyond your copay regardless of what kind of service was provided (e.g. intake, individual follow-up, couple or family follow-up). This rate is typically listed on your insurance card if you have a defined copay. You can also reach out to your insurance provider to identify your copay.
- Out-of-Network: If Dr. Swinton does not accept your insurance, you will be required to pay the self-pay rates at the time of service. We can then provide you with a superbill so you can submit it to your insurance provider to seek out-of-network reimbursement.
- How you pay: We take care billing the insurance company for you if we accept your insurance. Once we hear back from the insurance company, we will bill a credit or debit card on file in your chart. All patients wishing to bill a third party for treatment will be required to keep a credit or debit card on file that will be billed as soon as insurance is processed. We will do everything we can to increase the chance your insurance will cover your treatment. However there are uncommon situations where claims are rejected. In these cases you will be required to pay the self-pay rates for your treatment.