Why your health plan may be marked ineligible

There are many reasons why insurance may be marked as ineligible after our team's review. In the event this happens, Alma will send you an email explaining the reason, as well as next steps if we can make updates. Here are the most common scenarios you could encounter:  

You have insurance that Alma does not currently accept

Alma is contracted with several national and regional participating plans, including Optum, Aetna, Cigna, and Anthem Blue Cross and Blue Shield. 

You may have a health plan under one of these network partners, but the specific plan is managed by a third party administrator that Alma is not operationally set up to accept. If this situation applies, or if your plan is not managed by one of our network partners, your plan will be marked ineligible. See the list of payers accepted through Alma’s insurance program.

You have a health plan administered by Medicaid or Medicare

Alma does not currently accept Medicaid or Medicare. This includes plans that are managed by commercial insurance, such as community/state plans and Medicare Advantage. 

Your health plan hasn’t started yet

All insurance policies have an “effective date.” This is the date on which coverage becomes active. Often, payers do not display benefits for a policy that hasn’t kicked in yet. 

If we receive insurance details attached to a policy with a future effective date, we will mark your insurance status ineligible until the policy’s effective date. 

Your health plan has ended

If your policy has ended, this means you no longer have active coverage under that insurance policy for any dates of service after the termination date given by the health plan. 

If you believe you have active coverage through another policy that is in-network with Alma's insurance program, please contact your provider about updating your insurance details.

You need prior authorization in order for services to be covered in-network

“Prior authorization” means that your provider must get approval from your health plan before offering services in order for them to be covered by insurance. We see requirements for prior authorization most often around psychological testing. 

You can also contact your health plan by calling the number on the back of your insurance card to get more information about prior authorization requirements. 

You need a medical referral for services to be covered in-network

Sometimes you must obtain written confirmation to see a certain provider in-network. Unlike prior authorization, a referral is issued by another provider — either your primary care provider, or (if they have a student plan) a provider at their school’s health center. 

If we see that your plan requires a referral, we will call your insurance company to determine whether you have a referral on file for mental health services. If you do not, we will mark your plan ineligible. 

To get a referral, please reach out to your primary care provider and then email us at support@helloalma.com to let us know when the referral has been issued. Once we confirm that the referral has been uploaded to your health plan’s portal, we will complete an updated eligibility check. Learn more about insurance referrals

Our team isn’t able to locate an active health plan with the details you provided

If the Alma team cannot identify an insurance policy that matches the insurance details that you provided, we will mark you ineligible. If possible, we will add a note letting you know which piece of information we suspect may be incorrect. 

In these scenarios, it almost always helps our team if you or your provider can upload your insurance card, which often allows us to verify the details added to our portal. You can find more information about updating insurance details here: Adding Your Insurance Details to the Alma Portal

The insurance details submitted are for your secondary insurance

In cases where a client has two or more health plans, coordination of benefits is the process insurance companies use to determine which is the primary plan — the plan responsible for covering the client’s claims first. 

All other plans are called “secondary.” The client may be able to submit for additional reimbursement to these plans after the primary plan has processed their claims. 

Alma is not yet set up to accept secondary insurance. If we determine that the insurance details you submit correspond to your secondary insurance, we will mark you ineligible. If you have a primary policy that may be in-network with Alma’s Insurance Program, please add those details to the portal so we can run an updated eligibility check. 

Your health plan requires coordination of benefits

If your client has multiple insurance policies with multiple insurance companies, the insurance company will often request that your client designate one of these policies as primary before processing any claims. 

We will mark your client as ineligible while they complete coordination of benefits with their health plans. Learn more about coordination of benefits.

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