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.

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 session, 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 automatically refund or charge your payment method if your insurer confirms a different cost.

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

 

How Headway calculates session costs while benefits are being verified

To ensure that you can continue to access care, 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:

1. $40 temporary cost
   
   If you’re new to Headway or have new insurance, you can book sessions at a $40 temporary cost while we work to verify benefits. Clients on Headway often pay around this much per session.
2. Most recent session cost
   
   If you’ve previously had sessions on Headway, we can rely on information from your most recent session. Please note: In some cases, we’ll provide an estimate that is higher than your last session cost if our system detects your deductible or out-of-pocket maximum recently reset - a normal change that tends to happen once per year.

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 automatically refund or charge your payment method if your insurer confirms a different final cost.

An example of this could look like:

* The rates depicted above are for illustrative purposes only. 

While we’ve updated these options to help prioritize your continued care, you still have the option to cancel if you are not comfortable booking a session at your estimated cost. If you prefer to do this, we’ll cover any cancellation fees you would have incurred while verification is still in-progress, or up to 3 days after.

 

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.

 

 

Ineligibility after benefits reset 

When benefits reset, it’s possible that your plan may no longer be eligible for in-network care on Headway. Reasons for this include:

• If your plan no longer covers telehealth sessions
• If there is a change to your mental health coverage
• If your plan is no longer activeIf you switched to a new plan that is out-of-network

If this is the case, we recommend you: 

• Check that all your insurance details are up-to-date in your Headway portal (note, this should be your primary insurance).
• 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 are on a new or updated plan, it’s possible that your old provider isn’t covered, but a new one is. We recommend searching for a new in-network provider on Headway.
• If you are no longer in-network with all providers on Headway you can:
  • Talk to your provider about switching to private pay to continue care on Headway. Please note: If you are seeing your provider through Medicare or Medicaid, you will not be able to see your provider via private pay on Headway.
• Check your insurance company’s directory or other resources like Psychology Today for providers in your new network.