In January, it’s normal for insurance plans to reset. Below, you'll find some common scenarios that may occur, and how to navigate them to continue providing care.
Booking sessions while we wait for benefit verification
At the beginning of the year, it’s common for insurance companies to experience a high volume of plan updates. This can cause a delay in how quickly we can verify your client’s benefits and session cost estimates.
In your Headway portal, you'll easily see which clients have been impacted by a benefit reset, including whether their verification is in progress or if their insurance details need to be updated.
There are several statuses that may appear next to your clients, two of which relate to benefit verification: Verification in progress and Verified for scheduling.
Verified for scheduling
This means we have all of the benefit details we need, and your client is ready to be seen! You can schedule appointments as normal.
Verification in progress
This status means we're still working to verify benefits and estimate your client's session costs.
Even if a client is in the Verification in progress status, we want you to have the option to continue to provide care. You'll still be able to book sessions, but your client’s final cost may be different from the cost provided during this time.
To see the price we’ve shared with them, navigate to your Clients list and click on the name of your client. Then on the Billing tab, scroll down to the Pricing section.
We'll continue reaching out to their insurance company for information, and let you and your client know when we have an update. This typically takes 2-7 business days.
Lastly, you may see the status Insurance needs update. This likely means the insurance details we have for that client are now out-of-date and no longer active. If you know their new insurance details, you can update this from the Billing tab for that client. Alternatively, your client can update this in their Headway account.
How Headway calculates a client's cost while their verification is in progress
To ensure that you can continue to offer in-network care to your clients, we’ll do one of the following to calculate an initial estimate while verification is still in progress.
Based on the information we have, we’ll offer one of the following options:
-
$40 temporary cost
While we work to verify benefits, you can book sessions with your new clients at a $40 temporary cost. Clients on Headway often pay around this much per session. Once we get a finalized claim back from their insurer (which usually takes anywhere from 10-45 days after the session), we’ll automatically refund or charge your client’s payment method later if their insurer confirms a different final cost. -
Most recent session cost
If your client has had sessions on Headway in the past, we can rely on information from their most recent session. Once we get a finalized claim back from their insurer (which usually takes anywhere from 10-45 days after the session), we’ll automatically refund or charge their payment method later if their insurer confirms a different final cost. Please note: In some cases, we’ll provide an estimate that is higher than their last session for existing clients. We’ll do this when it’s likely the client’s deductible or out-of-pocket maximum recently reset - a normal change that tends to happen once per year.
We recommend discussing these options with your client as they come up. While we’ve updated their options to help prioritize continuity of care, your client still has the option to cancel. If they’d prefer to do this, we’ll cover any cancellation fees they would have incurred while verification is still in-progress, or up to 3 days after. This way, you’ll still be paid for your time, but your client won’t be penalized if the session cost was much higher than they expected.
When sessions are held, you will always be paid your contracted rate, regardless of what or how your client pays.
Price changes after benefits reset
It’s possible for your client’s cost per session to change when their plan resets or once we receive reliable information from their insurance company. This can happen for a variety of reasons outlined in our Benefits Guide. Common reasons include if their progress towards their deductible or out-of-pocket maximum reset, or if they enrolled in a new plan with different co-pays or co-insurance amounts.
If your clients’ costs change, we’ll notify them via email. Clients can also always view their benefits in their Headway account.
If your client has questions about changes to their cost per session, we recommend noting that changes are common during annual plan resets, and directing them to their benefits page for more details.
Ineligibility after benefits reset
When plans reset, it’s possible for a client to no longer be eligible for in-network care on Headway. Reasons for this include:
- If their plan is no longer active
- If there is a change to the mental health coverage in their plan
- If their plan no longer covers telehealth sessions
- If they switched to a new plan that is out-of-network
If this is the case, we recommend you:
- Ask your client to check that all their insurance details are up-to-date in their Headway portal, and if they have multiple plans, that these details match their primary insurance.
- Ask your client to contact their insurance company directly to confirm their eligibility, and reach out to us with a call reference number. From there we can work together on some next steps.
If it appears your client has lost coverage, you have a few other options:
- If your client is on a new or updated plan, it’s possible your client has become out-of-network with the plans you are credentialed with on Headway, but they are still in-network for other providers on Headway. If this is the case, we recommend helping them find a new in-network provider on Headway.
- If your client is no longer in-network with all providers on Headway, you can:
- Talk to them about switching to private pay to continue care on Headway. Please note: If your client is a Medicare or Medicaid client they will not be able to be seen via private pay on Headway.
- Cancel upcoming sessions on Headway with this client. You can then help them find a provider in their new network, using their insurance company’s directory or other resources like Psychology Today