Contacting Your Insurance Carrier

We understand that calling your insurance carrier can at times feel like an intimidating, or time-consuming task. We’ve been there ourselves and we’re here to guide you through it!

Information to have on hand when contacting insurance

To make calling your insurance carrier as seamless an experience as possible, and to avoid the need to call back and possibly wait additional time on hold, we recommend having the following information ready before you call:

  • Date of Birth
  • Member ID of primary insurance
  • Date of Service / Appointment Date if you have already started care
  • Primary subscriber name and date of birth (if you are not the primary subscriber)

What Alma has access to

Alma has access only to the following information regarding your insurance plan:

  • The insurance plan details you share with us such as your group number and member ID
  • The estimated payment responsibility your insurance carrier shares with our team based on your insurance details
  • The confirmed payment responsibility they share with us once they have finished processing your session claim

There is some information you can gather only from your insurance carrier directly, including your Explanation of Benefits. 

Once you’re ready to call

  1. Call the number on the back of your insurance card
  2. Say your Member ID
  3. Ask for Mental Health
  4. When a representative asks why you're calling:
    1. If you have questions about your payment responsibility, state "I am calling to verify my co-payment responsibility for mental health services.”
    2. If you are requesting an Explanation of Benefits, state “I am calling to request a copy of my Explanation of Benefits for the date(s) of service Month, Date, Year.”
    3. If you plan to dispute a claim, state “I am calling to dispute a claim for the date(s) of service Month, Date, Year.”
  5. The representative will likely ask you if this is your primary insurance, and whether you have any other insurance coverage. Once you respond, they will update their systems and provide you with your payment responsibility, or connect you with the correct representative to further assist.
  6. Ask the representative for a call reference number. If you might later need to share the information from your phone call with Alma’s Member Support team, a call reference number will help our team connect with the same representative to clarify any information and assist.

During the Change Healthcare Outage

If your health plan has been impacted by the Change Healthcare outage, your insurance carrier may not yet have full insight into 

  • The number of claims submitted by your healthcare providers (Alma or otherwise) since February, 2024 or
  • The impact of these outstanding claims on your deductible for 2024.

That said, you can be proactive about confirming your expected payment responsibility even while systems are down. Make sure to bring the following information to your call with your health plan:

  • The number of Alma sessions that you have had since February 21, 2024 (For example: "I've seen my therapist for 5 sessions since the end of February") and
  • The payment responsibility you have been quoted in Alma eligibility checks (For example: "Alma's eligibility checks show a $120 - $130 cost range for each session.")

Based on this information, you can ask your health plan representative to confirm: 

  • How much of my deductible balance will remain after these claims are processed?
  • Will my payment responsibility change once these claims are processed? and 
  • How much can I expect to pay per session after my claims are processed?

By reaching out proactively to your health plan to verify what you can expect next, you can take control of your benefits even during this period of flux.

Verifying your Eligibility

If you would like to confirm your insurance plan’s eligibility for coverage of your sessions, or if Alma’s eligibility team has marked your insurance plan as ineligible and this needs to be corrected, you can connect with your insurance carrier for more information. They will be able to share the exact start and expiration dates of your plans, and the details of your coverage.

Explanation of Benefits

An Explanation of Benefits (EOB) is is a written explanation of your claim, showing what portion of the cost your insurance company has covered, and the portion of the cost you owe as the client receiving care. An EOB is created when your insurance carrier finishes processing the claim. If you have questions about your payment responsibility or any invoice adjustments, you may contact your insurance carrier and request a copy of your EOB to see a full breakdown of the session cost. 

Some insurance companies send a physical EOB through the mail for all claims, while others will allow you to access online EOBs through a unique log-in to their portal. To request a copy of your EOB from your insurance carrier, you can call the Claims Department phone number, usually listed on the back of your insurance card.

Disputing a claim

The cost of a session ultimately determined by the insurance carrier. As the insurance policyholder, if you disagree with the cost of a session, you may choose to dispute the claim. Claims for sessions conducted and submitted through Alma cannot be disputed through Alma and must be disputed with the insurance carrier directly. To dispute a claim, call your insurance carrier’s Claims Department; the phone number is most likely listed on the back of your insurance card.

Additional Information from Your Insurance Carrier

If you have questions about any of the following topics, you can find information from Alma’s Support Center below:

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