As we approach January 1, it's essential to take a moment to review your health insurance benefits. Many plans reset their deductibles at the start of the calendar year, affecting how your benefits are applied and how out-of-pocket costs are handled. Here's what you need to know to be prepared for this transition and ensure uninterrupted access to your care.
What Happens When Benefits Reset?
At the beginning of each year, many health insurance plans reset their deductibles. A deductible is the amount you must pay out-of-pocket for covered services before your insurance plan begins to pay. Until your deductible is met, you may be responsible for the cost of services, which will be charged using the payment method we have on file. For 2025, the annual deductible for Medicare Part B beneficiaries will increase to $257, up by $17 from the previous year. If you are covered under Medicare, this change may impact your out-of-pocket costs for therapy services. If your plan has a copay or coinsurance, these may also Increase and be applied after your deductible is met. Understanding how your specific plan works is critical to avoiding surprises.
What Happens If Benefits Change?
Since we are in open enrollment, your insurance company/policy may change for the coming year. It is vital to inform our office of any changes to your insurance coverage (both primary and secondary). Insurance companies do not notify us of any changes to your policy/coverage. You must ensure that your clinician is participating in the new insurance plan if you want the plan to pay for their services. Not all of our clinicians participate in all insurances, so it is essential to know whether a change occurs, whether your clinician is participating, and how that may affect your out-of-pocket costs.
What Happens if Your Insurance Benefits Are Terminated?
If, for any reason, your insurance benefits terminate or lapse (Medicaid included), you are responsible for the total cost of services provided. For Medicaid recipients, therapy services are typically fully covered. However, if Medicaid coverage is terminated, you are responsible for all associated fees for services provided after coverage ends. Suppose you find that your insurance benefits are no longer active. In that case, we completely understand if you need to pause services temporarily. However, please note:
- We cannot carry balances or offer payment plans. Payment for most services rendered is due at the time of service. (Court-related services require pre-payment).
- Unpaid balances may result in a pause or termination of services. It is essential to address outstanding amounts promptly to avoid disruptions to your care.
- Keeping your account up-to-date ensures transparency and avoids unexpected financial burdens. By staying proactive, we can work together to ensure a smooth experience and make any necessary adjustments to your care plan.
How to Prepare:
- Review Your Benefits: Contact your insurance provider or log into your insurance portal to review your benefits for the new year. Key details to check:
- Deductible amount (e.g., Medicare Part B's $257 for 2025)
- Copay/coinsurance rates
- Coverage for specific services provided by your clinician at our practice; ensure they are in the network with your carrier and that you can use out-of-network benefits if they are not.
- Verify Your Personal Information: Log into our portal to ensure your contact information is updated and correct. Most insurance companies will deny claims if the address listed on the claim differs from the insurance company's system. Keeping your phone number, email, and address up to date in our system ensures we can quickly contact you if problems arise.
- Update Your Insurance Information: If your insurance plan or provider changes in the new year, please provide us with your updated information before your next appointment. Keeping your file current helps us process claims smoothly and accurately and prevents delays.
- Verify Your Payment Method: Ensure your credit card information is up-to-date in our system to prevent service disruptions, especially if your deductible resets or insurance issues arise, as charges may be applied to cover your out-of-pocket costs.
- Plan Ahead: If your deductible resets, you may notice a change in your out-of-pocket expenses. Setting aside funds to cover these initial costs can help you quickly transition into the new year.
Your Responsibility as a Client
While we're here to help, understanding your insurance benefits is ultimately your responsibility. Insurance policies are a contract between you and the insurance company. We do not dictate the deductible/copay rates. Because insurance policies can vary widely, we cannot provide you with a guarantee of what your benefit coverage will pay. Staying informed is ultimately your responsibility and ensures you're prepared for any changes should they occur. If you have questions about your plan, your insurance provider is the best and only source of information.
We're Here to Help
If you're unsure about the information we have on file or need assistance updating your account, please don't hesitate to contact our office at (864) 501-6484, or email Job, our practice manager, at Office@beautyforashescounseling.org. Our goal is to make your experience as seamless as possible, and we're happy to answer any questions you may have about how your benefits process through our system.
By taking these simple steps now, you can avoid surprises and continue receiving care without interruption. Thank you for choosing us for your mental wellness needs—we look forward to supporting you in the new year!
