Important considerations about your health insurance.

At ClearInsight Psychiatry, we feel it is important to not only educate and empower patients on medical matters but also on healthcare in general. Please read through the following article on what you should consider when proceeding with health insurance.

Healthcare is expensive – that is why we have health insurance! But it is not that easy. While health insurance should make healthcare more affordable, knowing what or how much your insurance will cover can be nebulous until you get the bill, especially if you do not have a full picture of what your insurance will cover before your appointment. Thus, we highly encourage patients to do their due diligence on their insurance plan prior to setting up an appointment. 

To gain a better understanding of their insurance plan, patients should call their insurance. The contact number is often on the insurance card.

Some questions to ask are:

• Is ClearInsight Psychiatry / Dr. Liang in my network?
  • Insurances contract with providers (physicians, psychologists, etc.) to create a network of providers for their customers. If we are not in your network, then we are not contracted with your insurance and it is likely your insurance will not cover your visit with us.
• Do I need a referral from my primary care provider to see Dr. Liang?
  • If you have an HMO plan, it is likely that you will need a referral to see us. If you see us without a referral, your insurance likely will not cover your visit. Please double-check with your insurance!
• If ClearInsight Psychiatry is not in my network, do I have out-of-network benefits, what are they, and how do I use them?
  • Some insurance plans offer out-of-network benefits where your insurance may pay a portion of your costs when you see an out-of-network provider. Sometimes insurances ask you to fulfill an out-of-network deductible before your benefits start kicking in.
  • If you would like to use out-of-network benefits, you may have to submit a claim yourself to your insurance. At ClearInsight Psychiatry, we are happy to provide invoices if needed.
• What is my co-pay for psychiatry visits?
  • Co-pay is a cost-sharing amount that a patient has to pay at each appointment. The amount is determined by your insurance and is often listed on the insurance card. 
• What is my deductible?
  • A deductible is an amount you pay each year before your insurance starts paying. For example, John has a deductible of $5,000. John has to pay $5,000 in eligible medical costs before his insurance starts paying. 

For more transparency, here is what happens when we bill your insurance.

1. We send in a claim listing the services performed.
2. The claim is either accepted or denied. If denied, we have to appeal, and this process can repeat multiple times and take months.
3. If the claim is accepted, your insurance will send us an EOB (Explanation of Benefits). The EOB is specific to a patient’s insurance plan and will list what price the insurance determines the service to be, what the insurance will pay for the service, and what the patient responsibility is. You should also receive an EOB in your mailbox. When you receive it, please call our office to pay your responsible amount.
   1. It is impossible to know what insurance will pay for prior to receiving the EOB.
   2. The pricing for services (a.k.a. fee schedule) is set by the insurance and is often tied to the location of the practice (i.e. San Diego). We do not have control over the fee schedule or the determination of what your insurance will cover.
4. In the EOB, the insurance says that our office is now responsible for collecting the insurance-determined amount that the patient is responsible for. Thus, you may receive a charge on your credit card from us (for our policy that patients agree to, please see Credit Card Coverage form on https://clearinsightpsychiatry.com/instructions-and-forms/). If you have any questions about any charges, please contact our office and we are happy to send you your EOB.

We hope that this article has helped you understand what to look for with your insurance and how medical billing works. It can be convoluted and frustrating, but we hope with this knowledge you can be empowered to make decisions better for your health and for your wallet.