How Does Alma Conduct Eligibility Checks?

To verify your insurance benefits, our team conducts eligibility checks using the policy information that you provide to us. The following video takes an in-depth look at Alma's eligibility checks.

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How does Alma calculate my estimated cost for each visit?

Prior to every visit, Alma uses the insurance information you provided during the intake process to search for your insurance plan details by accessing your insurance payer portal or calling your insurance payer directly. 

Once our team locates your insurance plan, we search for your mental health benefits in your insurance portal to determine your estimated responsibility for each visit. From there, we communicate that estimated cost to you via email.

Alma conducts eligibility checks at the following points: 

  1. Before your first visit with your provider (Note that we require 1 business day to complete these eligibility checks)
  2. On a monthly cadence, if your provider informs us that your care is ongoing
  3. Any time your insurance details are updated in the Alma Portal

If you want to calculate costs before finding a therapist through Alma, we recommend checking out our blog post: Does Insurance Cover Therapy? How to Calculate Your Cost

Will the estimated cost in my eligibility email change?

As mentioned in the eligibility email, the cost that we quote you for every visit is an estimate and is subject to change. 

Your insurance company ultimately decides what you owe for each visit, and as a result, they may process your claim with a different cost than what was initially quoted.  

While we attempt to provide the most accurate estimate up front, there can be many complexities within each plan that can lead to a difference in cost when the claim processes. Since this is determined by your health plan and not by Alma, we are only able to relay information that we have access to at the time of the eligibility check. 

Note that insurance claims processing can take 45-60 days. Health plans can also reprocess claims weeks or months after the initial processing if they identify an error in their internal systems after the fact. 

Am I able to check my own estimated cost? 

The best way for you to stay on top of the nuances of your insurance benefits is to reach out to your health plan directly by calling the number on the back of your insurance card. For guidelines on information you can request from your health plan, review: Contacting Your Insurance Carrier

In particular, we strongly recommend that you get in touch with your health plan if you believe you are close to paying off your deductible, or if you want to verify whether or not your deductible applies to mental health visits. You can find more information about deductibles here: Understanding Your In-Network Coverage

If you confirm with your health plan that you should be charged a different amount for your Alma sessions, you can reach out to to request invoice updates. 

If you are able to share a call reference number from the agent you speak to, that information will also assist our team in confirming updates with your health plan directly. 

What occurs if my claim processes with a different cost?

If your health plan processes your claims with a different cost than our initial estimates, our team will adjust your past invoices accordingly. We will also update your eligibility check to reflect the cost your insurance says you owe for future visits. 

You can locate the final amount you owe on your Explanations of Benefits (EOB) once your health plan has finished processing your claim. Your health plan may make your EOB available either through email or through their online portal. You can review this article for guidance in reading your EOB. 

Alma will always invoice you the amount indicated on your EOB.

  • If you owe less than Alma’s original estimate, we will issue you a refund and adjust future eligibility checks to match the updated cost determined by your health plan.
  • If you owe more than Alma's estimate, you will be issued an invoice for the difference between the initial quoted cost and the final cost listed on your EOB.

For more information on insurance cost changes, you can review: How Alma Processes Claims.

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