Navigating a benefit reset

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. 

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 benefits and provide an estimate for your session cost. 

If this is the case, we’ll let you know that your benefits are still being verified in your appointment confirmation email and your Headway portal. 

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Seeing your provider while your benefits are being verified

While benefit verification is in-progress, you'll still be able to book sessions, but your estimated cost may be different based on the information we have from your insurance company. Before your appointment, you'll receive an email directing you to your Headway portal to view your price while your benefits are being verified. 

At this point, you can keep the session and once we get a finalized claim back from your insurer (which usually takes anywhere from 10-45 days after the session), we’ll refund the difference if the actual cost is lower than our estimate, or send you a second bill if it’s higher than our estimate.

Alternatively, if you would like to wait until your benefits are verified (which usually takes 2-7 business days), you can cancel the appointment without a fee. 

 

How Headway calculates session costs while benefits are being verified

To ensure that you can continue to access care, 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:

  1. Full in-network cost

    While we work to verify benefits, you can book sessions at the full-in-network cost. 
  2. Most recent session cost

    If you’ve previously had sessions on Headway in the past, we can rely on information from your most recent session. 

In either scenario, once we get a finalized claim back from your insurer (which usually takes anywhere from 10-45 days after the session), we’ll refund you the difference if the confirmed cost is lower than what we charged, or send you a second bill if it’s higher than what we charged.

Please note: In some cases we may charge full in-network cost even if you’ve previously had a session on Headway if our system expects your deductible or out-of-pocket max has just reset. We’ll let you know if this is the case.

 

An example of this could look like: 

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* The rates depicted above are for illustrative purposes only. 

If you are not comfortable booking a session at the full in-network cost or most recent session cost, you will be able cancel your upcoming session without any fees. 

 

Price changes after benefits reset

It’s possible for your cost per session to change when your plan resets or once we receive verification from your insurance company. This can happen for a variety of reasons outlined in our Benefits Guide. Common reasons include if progress towards your deductible or out-of-pocket maximum reset, or if you enrolled in a new plan with different copays or co-insurance amounts. 

If your costs change, we’ll notify you via email. You can also always view details around your benefits in your Headway account.

 

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Ineligibility after benefits reset 

When benefits reset, it’s possible that your plan may no longer be eligible for in-network care on Headway. This could happen if your plan is no longer active, if there is a change to your mental health coverage, or if you switched to a new plan that is out-of-network.

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If this is the case, we recommend you: 

  • Check that all your insurance details are up-to-date in your Headway portal. 
  • Contact your insurance company directly to confirm eligibility, and reach out to us with a call reference number. From there we can work together on some next steps.

If it appears you have lost coverage, you have a few other options: 

  • If you were seeing this provider through Headway before your benefits changed, you can talk to your provider about switching to private pay to continue care on Headway. 
  • Check your insurance company’s directory or other resources like Psychology Today for providers in your new network. 

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