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.
Checking client benefits
To give you more control and visibility over client coverage, we have tools to help you verify details quickly.
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Check insurance eligibility pre-booking
You can now check whether you accept a potential client's insurance and view their estimated costs before adding them to your Client list. This allows you to confirm eligibility and set expectations early. -
Refresh benefits button
If you believe an existing client's coverage information is out-of-date, you can use the Refresh benefits button to triggers a real-time check for any updated plan details. -
Report incorrect benefits
If you notice a discrepancy or believe a client’s insurance details look incorrect, you can flag issues directly from the provider portal (via the insurance checker or client's page).
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 status badges that may appear next to your clients:
Client status badge explanations
No status badge visible
If the client has no status badge next to their name, it 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.
No remaining sessions
This indicates that the client has reached the maximum number of covered sessions allowed by their insurance plan. Once this limit is met, the client is no longer eligible to be seen using their insurance benefits. If you’d like to continue care, you may discuss out-of-network or private-pay options directly with the client.
Out-of-network (not credentialed)
This means the client is considered in-network with Headway, but you are not credentialed with their specific insurance plan or you’re not licensed to practice in the state where the client is located. Because of this, the client cannot see you using their insurance benefits.
Not accepted on Headway
This means the client’s insurance plan is fully out-of-network with Headway. Because the plan isn’t supported on our platform, the client can’t use their insurance benefits for sessions with any Headway provider.
Plan no longer active
This means the client’s insurance coverage is no longer active according to the information returned by their insurer. Because the plan is inactive, the client isn’t eligible to use insurance benefits for sessions until they update their coverage.
No mental health benefits
This means the client’s insurance plan does not include coverage for mental health services. As a result, the client isn’t eligible to use their insurance benefits for therapy or psychiatry sessions.
Coordination of benefits issue
This indicates that the client’s secondary insurance has been reported to the insurer as their primary plan. Until the client updates their coordination of benefits with their carrier, their coverage may appear inactive or may not process correctly.
Cost calculations while insurance 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:
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$40 temporary cost
If your client is new to Headway or has updated their insurance, we may need time to verify their specific benefits. To avoid delaying care, clients in this status can book sessions at a temporary $40 cost. This serves as a placeholder based on the typical cost of care across our network.
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 for that client's insurance plan, 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, and complete appropriate termination and documentation needed. You can then help them find a provider in their new network, using their insurance company’s directory or other resources like Psychology Today