How Health Insurance Works

Most people get health insurance in one of these ways:

• Through an employer

• Through the health insurance marketplace (MNsure in Minnesota)

• Through a government program, such as Medicare, TRICARE, or Minnesota Health Care Programs like Medical Assistance (MA) and MinnesotaCare

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When you enroll in a plan, you enter into a contract with an insurance company. You will receive an insurance card and documents that explain your coverage.

Most people have one insurance plan. Some also have secondary insurance, which is an additional plan that may help pay costs your primary plan does not cover.

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Your Responsibilities as a Client

• Provide accurate, up-to-date insurance information

• Let us know right away if your coverage changes

• Tell us if you have more than one insurance plan

• Sign the Insurance Authorization Form, which is included in your intake packet and must be signed again if your insurance changes

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Cost Sharing

Many plans require members to pay part of the cost of their care. This is called cost sharing. Common types include:

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• Deductible: The amount you pay for covered services each plan year before your insurance begins to pay. Some plans cover certain services before the deductible is met.

• Coinsurance: After you meet your deductible, some plans require you to pay a percentage of the cost of a service. Your insurance pays the rest of the approved amount.

• Copayment (Copay): A fixed amount you pay for a visit. Your plan sets the amount, and it is due at the time of your appointment.

• Out-of-Pocket Maximum: The most you will pay in a plan year for covered, in-network services. It includes your deductible, coinsurance, and copays. Once you reach it, your plan pays 100% of covered services for the rest of the plan year. Your monthly premium does not count toward this limit.

 

In Network

In-network providers are clinics and clinicians that have a contract with your insurance company. Seeing an in-network provider usually costs you less.

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The Luminous Mind is in network with:

• Aetna

• Blue Cross Blue Shield

• First Health

• HealthPartners

• Medical Assistance (MA/Medicaid)

• Medicare Part B

• TRICARE West (TriWest)

• UCare

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Important: Having one of these plans does not guarantee that your services will be covered. Coverage depends on the details of your individual plan. To confirm coverage for services at The Luminous Mind, please call your insurance company directly. They may ask for our NPI (National Provider Identifier): 1588015168.

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Out of Network

Out-of-network providers are clinics or clinicians that do not have a contract with your insurance company. If you see an out-of-network provider, you may pay more or all of the cost, face a separate or higher deductible, and need to submit claims yourself. Always check your plan's out-of-network benefits before starting services.

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Explanation of Benefits (EOB)

An EOB is a statement your insurance company sends you after it processes a claim from your provider. It shows what was billed, what your plan paid, and what you may owe. An EOB is not a bill.

Coordination of Benefits (COB)

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Your insurance company may ask you to call and update your COB information. This means they want to know whether you have more than one insurance plan. If you do, they use this information to decide which plan pays first.

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Prior Authorization

Some plans require approval before certain services are provided. This is called prior authorization (or pre-authorization). If your plan requires it, the service must be approved before it takes place, or your insurance may not cover the cost.

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If We Are Out of Network With Your Plan

You have several options:

• Find an in-network provider. Contact your insurance company and ask for a list of in-network providers who offer the services you are looking for.

• Request a Single Case Agreement (SCA). An SCA is an agreement between your insurance company and an out-of-network provider that allows you to receive care from that provider for a specific service and time period at an agreed-upon rate. Each insurance company has its own process, so contact them directly to ask about their requirements.

• Use your out-of-network benefits. Some clients use their out-of-network benefits after speaking with their insurance company. If you choose this option, we can provide superbills (detailed receipts you can submit to your insurance for possible reimbursement).

• Pay out of pocket. Some clients choose to pay privately because they do not have insurance or prefer not to use it. If you choose this option, you may complete a Sliding Fee Application to reduce the cost of services. If you receive a reduced rate through the sliding fee scale, you will not be eligible for a superbill.

• If you pay out of pocket, you will receive a Good Faith Estimate of your expected costs before services begin, as required by federal law.

Please note: If you choose to pay out of pocket instead of using your insurance, we will not bill your insurance later for sessions you have already paid for.