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’ll send you an email explaining why and what to do next.
| Note: If you choose to continue care after learning your plan is out-of-network (OON), you will be 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) showing that your claim was denied. Don’t worry, your benefits will remain eligible in the Alma portal. Once we hear back from your insurance company, we’ll follow up with you and your provider about next steps.
See below for common reasons why Alma may not be in-network with your plan.
1. 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 lis of participating insurance plans, see Participating Insurance Plans.
2. Your plan is through Medicare or Medicaid
Alma doesn’t partner Medicaid or Medicare plans. This includes community or state-based plans and Medicare Advantage plans managed by private insurers.
3. Your plan hasn’t 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 will only cover your care once it becomes active.
4. 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If your policy has ended, your coverage is no longer active for any new sessions.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.
5. Your plan requires prior authorization
Some plans need prior authorization, meaning your provider must get approval from your insurance company before your plan will cover 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.
6. 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.
Sometimes, you must get written confirmation to see a certain provider in-network. 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: Learn more about insurance referrals.
7. Alma can’t find your plan details
If our team can’t locate your policy using the details you provided, we’ll contact you. In most cases, uploading a clear photo of the front and back of your insurance card helps us verify your plan quickly. To learn more, see Adding Your Insurance Details to the Alma Portal.
8. 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’ll notify you and request your primary plan details so we can recheck eligibility.
9. Your plan requires coordination of benefits
If you have multiple insurance policies, you’ll 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 Coordination of Benefits.