Insurance can feel confusing, so Alma created this guide to explain how your benefits work. Here, you’ll learn how Alma checks your insurance, estimates your cost, and bills you after each session.
Eligibility Checks
You can add and manage your insurance information directly in your Alma client portal. This allows you to check your benefits and view an estimated cost per session at any time. When you add or update your insurance information, Alma reviews your benefits to confirm:
- Your insurance coverage is active
- Your plan covers the services you’re receiving
- Your estimated cost per session (what you’ll owe your provider)
| Note: Your provider can still submit your insurance information on your behalf. |
If your insurance plan changes, you can update your details in the client portal or work with your provider to make the update. Once new information is updated, Alma will review your benefits again and update your cost estimate if needed.
If you have Aetna, Cigna, Oxford, or UnitedHealthcare (UHC), you can use Alma’s Cost Estimator Tool to view your estimated cost for in-network mental health care. You can also read our blog post Does Insurance Cover Therapy? and How to Calculate Your Cost for more guidance.
Understanding Payment Responsibility
Insurance companies contract with providers in their network to offer care at set rates, called contracted rates. You and your insurance company each pay a part of that rate. You pay your payment responsibility and your insurance company pays the rest. Depending on your insurance plan, your payment responsibility can range from $0 up to the full cost of the contracted rate.
Your payment responsibility usually comes in one of two ways:
- Copay: You pay the same amount for each visit regardless of the contracted rate, and your insurance covers the rest.
-OR-
- Coinsurance (after meeting your deductible): You pay a portion of your provider’s contracted rate, and your insurance covers the rest. Typically, plans with a coinsurance require you to pay the full contracted rate until you meet your deductible. Then, your insurance will cover a percentage of all costs.
Deductibles and Out-of-Pocket Maximums
Your deductible is the total amount you must pay each year before your insurance begins covering costs.
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Example:
If your plan has a $1,000 deductible and a $20 copay per session, you’ll pay $20 per visit until your total medical spending reaches $1,000. After that, your cost drops to $0 per session.
Your out-of-pocket maximum is the most you’ll pay for covered services in a plan year. Once you reach that limit, your insurance pays 100% of covered care for the remaining of the year. Any money you spend on deductibles, copays, and coinsurance counts toward your out-of-pocket maximum. However, premiums don't count and neither does anything you spend on services that your plan doesn't cover.
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Example:
If your plan has a $2,000 deductible and 100% coinsurance until you meet it, you’ll pay the full contracted rate (for example, $100 per session) until you reach $2,000. After that, your plan covers your visits in full.
How Alma Keeps Track of Your Deductible
Alma runs monthly eligibility checks when your provider uses the Alma calendar to schedule sessions. If your deductible changes, resets, or you shift to a copay or coinsurance, we will automatically update your cost.
When you are within $200 of meeting your deductible, Alma will email you and begin billing as if your deductible is already met. This helps prevent overcharging if your remaining balance is smaller than a full session cost.
If we later learn that you owe more than the estimate, Alma will send an updated invoice for the difference.
Billing and Invoices
After each session, your provider submits a claim to your insurance company. You’ll then receive an invoice based on your payment type:
- Copay: You will receive an invoice soon after your session.
- Coinsurance: You will receive an invoice after your insurance company processes the claim, which typically takes 45–60 days.
Sometimes your final invoice differs from your original eligibility estimate. This happens when:
- You meet your deductible between the eligibility check and the claim being processed.
- Your session details change (for example, from a 45-minute to a 60-minute appointment, which has a different contracted rate).
| Note: Your insurance company decides the final amount you owe, and Alma adjusts your invoice to match that determination. |