Use this article to understand how Alma verifies your insurance benefits and estimates what you may owe for each session.
How Alma Verifies Insurance Benefits
Alma uses the insurance information you provide to complete an eligibility check with your insurance company.
What Is an Eligibility Check?
An eligibility check is a review of the insurance information you provide to Alma. During the review, Alma works with your insurance company to:
- Confirm your coverage is active.
- Verify your benefits.
- Estimate how much you may owe for each session.
| Note: An eligibility check provides an estimate based on the information your insurance company shares at the time of the review. Your insurance company determines the final amount you owe after your claim is processed. |
To learn more about how eligibility checks work, watch the video below.
When Does Alma Check My Insurance?
Before each visit, Alma uses the insurance information you provide to estimate your payment responsibility.
We check eligibility:
- When you add or update your insurance information in the Client Portal
- Three days before an appointment scheduled by your provider on the Alma Calendar
- Monthly, if you've had an appointment or claim in the last 90 days and your eligibility hasn't been checked in the last 30 days
- When you or your provider request an updated eligibility check.
When your eligibility check is complete, we'll email you with your estimated cost. Your Alma Client Portal will always display your most up-to-date eligibility status and estimated cost.
To learn where to find your estimate, see: View Your Cost Estimate in The Alma Portal.
Why Can My Cost Estimate Change?
Your estimated cost may change if:
- Your insurance benefits change.
- Your deductible, copay, or coinsurance changes.
- Your insurance company provides updated information after your eligibility check.
Your insurance company determines the final amount you owe after processing your claim.
For more information, see: Why Was I Charged More Than Expected?
What If My Cost Estimate Looks Incorrect?
If you believe your eligibility status or estimated cost is incorrect:
- Contact your insurance company to confirm your current benefits.
- If the information still doesn't match, contact Alma using the Help button in the Client Portal. Our team can review your eligibility information and investigate any discrepancies.
Confirm Your Benefits With Your Insurance Company
Your insurance company is the best source for questions about your coverage and benefits.
Consider contacting your insurance company if:
- You're close to meeting your deductible.
- You want to confirm whether your deductible applies to mental health services.
- Your insurance coverage has recently changed.
- You'd like to verify your copay or coinsurance before your appointment.
Use the phone number on the back of your insurance card. For guidance on what to ask, see Contacting Your Insurance Carrier.
To learn more about how deductibles, copays, and coinsurance work, see Understanding Your In-Network Coverage.
If your plan gives you a different cost than Alma’s estimate, contact us using the Help button at the bottom right of your screen.