How Alma Verifies Your Insurance Benefits and Estimates Your Cost

How Alma Verifies Insurance Benefits

Alma reviews the insurance details you provide by conducting an eligibility check to verify your benefits, confirm coverage, and estimate your cost per session. To learn more, see the walkthrough below:

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How Alma Estimates Your Cost Per Visit

Before each visit, Alma uses the insurance information you provided to estimate your payment responsibility for each visit. We then communicate that estimated cost to you via email. You can also check your client portal for the most up-to-date cost estimate. To learn how, see: View Your Cost Estimate: What You Will Pay After Each Session

We check eligibility:

Anytime you update insurance details or add future insurance details in the Alma portal.
3 days prior to any appointment scheduled on the Alma Calendar by your provider.
Monthly, if you’ve had an appointment or a claim in the last 90 days and your eligibility hasn’t been checked in the last 30 days.
When an eligibility check is requested by a provider.

You can also estimate your cost ahead of time by reading our blog: Does Insurance Cover Therapy? How to Calculate Your Cost.

Why Costs Can Change

The amount in your eligibility email is only an estimate and is subject to change. Once your claim is processed, your insurance company makes the final decision on how much you owe. Alma only relays the information we have access to during the eligibility check.

Insurance claims usually take 45–60 days to process, and some plans may review or reprocess claims later.

Note: If you believe your eligibility check contains an error, contact us using the Help button at the bottom right of your screen.

In your message, include:

A call reference number from your insurance company

An Explanation of Benefits (EOB) showing Alma’s estimate is incorrect.

Your insurance company makes the final decision about how much you owe for each session. This information helps Alma quickly review and resolve any differences in cost. If the amount on your EOB differs from the estimate in your eligibility check, Alma will automatically update your invoice to match the finalized claim.

Checking Your Own Benefits

The best way to confirm coverage is to call your insurance company using the number on the back of your insurance card. For guidelines on information you can request from your health plan, see: Contacting Your Insurance Carrier.

We recommend doing this if:

You’re close to meeting your deductible
You want to confirm if your deductible applies to mental health visits

To learn more about deductibles, 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.

When Costs Change After a Claim

To locate the final amount you owe, see your EOB. For guidance on reading your EOB, see How to Read Your Explanation of Benefits (EOB).

If your insurance company processes a claim for a different amount than the original estimated cost, Alma will update your eligibility check to reflect the cost your insurance says you owe for future visits

If you owe less than Alma’s original estimate, we will refund the difference.
If you owe more than Alma’s original estimate, we will invoice you for the remaining balance.
- If you are enrolled in Autopay, you’ll get a 10-day notice before any charge.
- If you would like to request a payment plan, we’d be happy to help. To do so, use the Help button at the bottom right of your screen.

For more information on insurance costs, see: How Alma Processes Claims