Use this article to understand how billing works at Alma, including the insurance claims process. You'll learn how Alma submits claims to your insurance company, when you'll receive an invoice, and how your final session cost is determined.
How it Works
After your session, your provider submits information about your appointment to Alma. We then submit a claim to your insurance company on your provider's behalf.
The claims process typically follows these four steps:
- Your provider submits your session.
- Alma submits your claim to your insurance company.
- Your insurance company processes the claim.
- Alma updates your invoice, if needed.
Note: Before your first session, Alma verifies your insurance benefits and estimates your session cost. To learn more, see How Alma Verifies Your Insurance Benefits and Estimates Your Cost. |
Step 1: Your Provider Submits Your Session
After your session, your provider submits information about your appointment to Alma. Alma uses this information to submit a claim to your insurance company. Alma then:
- Submits a claim to your insurance company.
- Pays your provider for the session.
- Uses your insurance benefits and claim information to determine when you’ll receive an invoice.
Step 2: You Receive an Invoice
When you receive your invoice depends on how your insurance benefits work.
If you have a copay:
- You’ll typically receive an invoice shortly after your session.
If you have coinsurance:
- You’ll receive an invoice after your insurance company processes your claim. This typically takes 45–60 days after your provider submits the claim for your appointment.
For more information about paying your invoices, see How to Review and Pay Your Alma Invoice.
Autopay
If you're enrolled in Autopay, Alma automatically charges the payment method on file within 24 hours of an invoice being issued. Autopay also helps ensure your provider is paid promptly.
Step 3: Your Insurance Company Processes Your Claim
Once Alma submits your claim, your insurance company reviews it and determines the final amount you're responsible for paying.
Claims typically take 45 to 60 days to process. In some cases, insurance companies may review or reprocess claims later.
After processing your claim, your insurance company will send you an Explanation of Benefits (EOB).
Your EOB explains:
- How your claim was processed.
- How your insurance benefits were applied.
- How much your insurance company paid.
- The final amount you owe.
If you see an error in your EOB, call the number on the back of your insurance card to request a review. For guidance on what to have on hand when you call your health plan, read: Contacting Your Insurance Carrier.
Step 4: Alma Updates Your Invoice (If Needed)
Your insurance company makes the final decision about how much you owe.
Sometimes the final amount differs from Alma's original estimate because your insurance company processed the claim differently than expected.
When this happens, Alma updates your invoice to match your processed claim.
If you owe less than estimated
If you've already paid your invoice, Alma will automatically refund the difference to your original payment method.
You'll receive an email confirming the refund. Refunds typically appear within 14 business days.
If you owe more than estimated
If your insurance company determines that you owe more than originally estimated, Alma will send you an updated invoice.
If you're enrolled in Autopay, you'll receive 10 days' notice before your payment method is charged.
If you're not enrolled in Autopay, we'll email you an invoice that you can pay manually.
| Note: Invoices are due within 60 days. Alma sends weekly reminders for outstanding balances. |
If you need additional time to pay, you can request a payment plan by clicking the Help button in the bottom-right corner of the Support Center.
If Something Doesn't Look Right
My claim was denied
If your insurance company denies your claim, Alma will contact you and your provider to explain why the claim was rejected, as well as offering options for revising and resubmitting the claim.
My claim was processed incorrectly
If you believe your insurance company processed your claim incorrectly, contact your insurance company using the phone number on the back of your insurance card.
Ask for:
- An explanation of how the claim was processed.
- The representative's name.
- A call reference number.
If you contact Alma afterward, sharing the call reference number can help us investigate more quickly.
My claim was processed as out of network
If you believe your claim was incorrectly processed as out of network, contact your insurance company and ask them to review and reprocess the claim.
If your insurance company confirms the claim should have been processed differently, you can submit your Explanation of Benefits (EOB) to Alma by selecting the Help button in the bottom-right corner of the Support Center.
I disagree with my insurance company's decision
Your insurance company makes the final decision about your coverage and payment responsibility. If you believe that decision is incorrect, you can appeal it directly with your insurance company.
Because the appeal is between you and your insurance company, Alma cannot submit an appeal on your behalf.
To start an appeal:
- Call the member services number on the back of your insurance card.
- Ask your insurance company how to submit an appeal.
- Complete any forms they provide.
Your insurance company may ask for supporting documentation, such as:
- Medical records
- Session notes
- Prior authorization documentation (if applicable)
- A letter explaining why you're requesting the appeal
- Any additional information that supports why the services were medically necessary
Appeal requirements and timelines vary by insurance company. Your health plan will explain the next steps and any documentation they require.
Frequently Asked Questions
Why is my final session cost different from my estimate?
Your estimated session cost is based on the information your insurance company provided during your eligibility check.
After your session, your insurance company reviews your claim and determines the final amount you owe. In some cases, that amount differs from Alma's original estimate.
Your estimated session cost is based on the information available during your eligibility check.
Why do I receive my invoice after my claim is processed?
If your payment responsibility is based on coinsurance, Alma waits until your insurance company processes your claim before sending your invoice.
This helps ensure you're billed based on your insurance company's final determination rather than an estimate.
Where can I find my Explanation of Benefits (EOB)?
Your insurance company sends an Explanation of Benefits (EOB) after processing each claim.
Most insurance companies make EOBs available through their online member portal. If you can't find yours, contact your insurance company to request a copy.
What if I can't pay my invoice?
If you're unable to pay your invoice in full, you may be eligible for a payment plan.
To request one, select the Help button in the bottom-right corner of the Support Center and let us know you'd like to discuss payment options.
If you would like to split payments across set increments, you can request a payment plan.