Why Alma Doesn’t Participate with your Insurance Plan

There are a few reasons Alma might not partner with your insurance plan. If our team finds that your plan is out-of-network, we send you an email explaining why and what to do next.

This article covers whether Alma, as an organization, participates with your insurance plan overall. Even if Alma does participate with your plan, that does not mean every Alma provider participates with it too. For reasons a specific provider or session may not be covered, see Common Reasons Your Insurance May Not Cover Therapy.

Note: If you choose to continue care after learning your plan is out-of-network (OON), you are responsible for the full cost of sessions. If you want to continue therapy without using insurance, see How to Pay for Therapy Without Insurance Coverage.

At times, Alma must contact your insurance company to fix an issue with a denied claim. During this time, you may receive an Explanation of Benefits (EOB) that shows your insurance company denies your claim, but your benefits remain eligible in the Alma portal. Once we hear back from your insurance company, we follow up with you and your provider about next steps.

See below for the most common reasons Alma may not partner with your plan.

Alma Cannot Find Your Plan Details

If our team cannot locate your policy using the details you provide, we contact you. Uploading a clear photo of the front and back of your insurance card usually helps us verify your plan quickly. To learn more, see Add Your Insurance Information to the Alma Client Portal

Alma Does Not Partner with Your Insurance Company

Alma partners with several major insurance plans, including:

Aetna
Anthem Blue Cross and Blue Shield
Cigna
Optum

To view the full list of participating insurance plans, see Alma's Participating Insurance Plans.

You Listed Your Secondary Insurance

If you have more than one plan, your insurance companies use coordination of benefits (COB) to decide which plan pays first. Alma can only bill the primary insurance at this time. If we identify your plan as secondary, we notify you and request your primary plan details so we can recheck eligibility. For help figuring out which of your plans is primary, see Understand Primary and Secondary Insurance Coverage.

Your Plan Has Ended

If your policy has ended, your coverage is no longer active for any new sessions. If you have another active plan that partners with Alma, contact your provider to update your insurance details in the Alma portal.

Your Plan Has Not Started Yet

Every policy has an effective date, which is the day your coverage begins. If you send us insurance details before that date, your plan only covers your care once it becomes active.

Your Plan Has Special Limits

Some plans have a benefit maximum on how many sessions you can have, require a referral, or limit the number of virtual visits.

A referral is written confirmation to see a certain provider. Unlike prior authorization, a referral comes from another provider, usually your primary care provider, or (for student plans) a provider at your school's health center.

If your plan requires a referral, contact your primary care provider to request one. Once your provider issues the referral, let Alma know so we can confirm it in your plan's portal and complete an updated eligibility check. To learn more, see Understand Insurance Referral Requirements for In-Network Care.

Your Plan is Through Medicare or Medicaid

Alma currently supports Optum Medicare Advantage and dual-eligible clients (those with both Medicare and Medicaid). Alma does not currently support standalone Medicaid plans.

Your Plan Requires Coordination of Benefits

If you have multiple insurance policies, you need to tell your insurance company which plan is your primary plan. Once you do, Alma can bill that plan for your sessions if we partner with them. To learn more, see Resolving a Coordination of Benefits.

Your Plan Requires Prior Authorization

Some plans need prior authorization, meaning your provider must get approval from your insurance company before your plan covers services. This is most common for psychological testing. Call the number on the back of your insurance card to ask if your plan requires prior authorization.