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.
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 cost may be different based on the information we have. We suggest asking your client if they’re okay with paying the price we shared with them for their upcoming appointment, or wait until we have verified their benefits.
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.
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’ve put the following processes in place 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:
Full in-network cost
While we work to verify benefits, you can book sessions with your new clients at the full-in-network cost. Once we get a finalized claim back from their insurer (which usually takes anywhere from 10-45 days after the session), we’ll let your client know and refund them if the confirmed cost is lower than what we charged.
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 let your client know and issue a refund or send a second bill if the confirmed cost is different from what we charged.
Please note: In some cases the best estimate for an existing customer may be the full in-network cost if our system expects that their deductible or out-of-pocket maximum has just reset. We'll let you and your client know if this is the case.
We recommend discussing these options with your client as they come up. If they’d prefer to cancel and wait for more reliable information, we’ll cover any cancellation fees they would have incurred while verification is still in-progress. 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 can be if their plan is no longer active, if there is a change to their mental health coverage, or 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.
- 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 you were seeing this client through Headway before their benefits changed, you can talk to them about switching to private pay to continue care 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