How Alma Verifies Your Insurance Benefits and Estimates Your Cost

Use this article to understand how Alma verifies your insurance benefits and estimates what you may owe for each session.

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.

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 it processes your claim.

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. Alma checks eligibility:

When you add or update your insurance information in the Client Portal.
Three days before an appointment your provider schedules on the Alma Calendar.
Monthly, if you have had an appointment or claim in the last 90 days and Alma has not checked your eligibility in the last 30 days.
When you or your provider request an updated eligibility check.

When your eligibility check is complete, Alma emails you your estimated cost. Your Alma Client Portal always displays 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 Client Portal.

What if Alma Finds Updated Coverage?

Alma may periodically check available insurance information, including after a plan appears inactive, to help verify coverage, estimate benefits, submit claims, and avoid care disruptions. If Alma finds updated coverage that may belong to you, we may add it to your account as pending while we confirms your benefits. You can review, update, or remove insurance information in your Client Portal at any time.

How Alma Tracks Changes to 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, Alma automatically updates your cost estimate.

When you are within $200 of meeting your deductible, Alma emails you and begins billing you as if your deductible is already met. This helps prevent overcharging if your remaining balance is smaller than a full session cost. If Alma later learns you owe more than that estimate, Alma sends you an updated invoice for the difference.

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?

Billing and Invoices

After each session, your provider submits a claim to your insurance company. You then receive an invoice based on your payment type:

Copay: Alma sends your invoice soon after your session.
Coinsurance: Alma sends your 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 your eligibility check and your claim being processed.
Your session details change, for example from a 45-minute to a 60-minute appointment, which has a different contracted rate.

Your insurance company decides the final amount you owe, and Alma adjusts your invoice to match that determination. For more on how claims are processed, see: How Billing Works at Alma: From Claim to Invoice.

What if My Cost Estimate or Eligibility Status Looks Incorrect?

Contact your insurance company to confirm your current benefits. This is especially useful if:
1. You are close to meeting your deductible.
2. You want to confirm whether your deductible applies to mental health services.
3. Your insurance coverage has recently changed.
4. You want 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.
If the information still does not match Alma's estimate, contact Alma using the Help button in the Client Portal. Our team can review your eligibility information and investigate any discrepancies.

To learn more about how deductibles, copays, and coinsurance work, see: Understanding Copays, Coinsurance, Deductibles, and Out-of-Pocket Maximums.