Using Insurance
revised May 26th, 2024
Occasionally, it’s plausible to be credentialed for specific insurance and be stated as in-network for that plan and I mark them as out-of-network. The in-network status is a positive, bi-directional relationship for both the practitioner & insurance company.
This blog post will always have updated information regarding the insurance I accept and attempt to answer the pertinent question associated with using your insurance.
Does Samara accept private pay?
Yes. The private-pay fee, also referred to as cash-pay or self-pay, is $150 per therapy session.
Samara offers a subscription model for a reduced rate.
All private-pay sessions are invoiced through Headway. She does not accept actual cash as a form of payment.
I have insurance but I do not want to use it.
You are not required to use your insurance if you have it & choose not to use it.
My insurance company states Samara isn’t listed as an in-network provider.
There are two ways Samara can accept your insurance.
Sjo is paneled directly through an insurance company such as Cigna, or
Sjo is included in the group network of an insurance broker such as Alma, & Headway who are contracted with groups of insurance companies such as Cigna.
Samara will state how she will invoice your insurance during your free consultation. If you request verification of Samara’s status as a provider with your insurance you must clarify how she is paneled with your insurance company (as stated in the consult) to view the correct network group.
insurance networks & plans
Understanding Samara’s preferred insurance.
In-network
Sjo defines an in-network insurance plan or policy where Samara is a verified credentialed provider & possesses a formal amicable relationship.
Depending on your insurance you will
Pay your co-pay only.
Or you will pay the maximum allowed for therapy services as defined by your insurance until your deducible is met.
Sjo In-network Insurances & Plans
Aetna ⬦ Aetna Boon-Chapman ⬦ Aetna GEHA ⬦ Aetna Meritain ⬦ Blue Cross Blue Shield (BCBS)* ⬦ Optum/United-EAP (TX) ⬦ Oscar Health Plan ⬦ United All Savers ⬦ United BIND ⬦ United GEHA/Shared Services ⬦ United Healthcare (TX) ⬦ United HealthScope Benefits (TX) ⬦ United Healthcare Golden Rule ⬦ United Oxford (TX) ⬦ United Student Resources (TX) ⬦ United UMR
*All Blue Cross Blue Shield (BCBS) plans are accepted, excluding Magellan BCBS.
Out-of-network (Oon)
Sjo defines an out-of-network insurance plan or policy with which Samara may or may not be credentialed or does not have a formal relationship.
Your insurance is defined as Oon by Sjo
if your insurance or plan is not listed under “Sjo in-network insurances & plans,” or is one of the following:
Apostrophe ⬦ Blue Cross Blue Shield TX HMO, Blue Cross Blue Shield Magellan ⬦ Cigna ⬦ Cigna Scott & White Healthplan
Note, it may not be financially beneficial to submit an out-of-network claim when compared to cash-paying Sjo’s fee. Contact your insurance representative to understand the cost analysis of out-of-network insurance and make an informed decision.
All out-of-network plans are processed via the insurance broker and processor Headway.
Clientele that choose to submit an insurance claim out-of-network will
Pay Sjo’s therapy fee via Headway.
Headway will issue a superbill** to the client at the beginning of each month for the client to submit to their insurance for reimbursement.
Reimbursement may be subject to your plan’s deductible.
**The term ‘superbill’ seems unfitting. It acts as a summary of services rendered to process a claim for reimbursement from the client’s insurance company, where the client claims a reimbursable service from an out-of-pocket expense where 100% of the services were paid for by the client.
Oon superbill example:
A client’s EDF plan is out-of-network. They had three therapy sessions in January totaling 450 paid by the client to Headway.
On the 1st, Headway sends a 450 superbill to the client. The client forwards the superbill to their insurance plan to be reimbursed.
In this hypothetical example, the client receives the maximum allowed for therapy sessions as defined by the client’s insurance which is 75 per session less their co-pay of 25.
Fees in this example are:
Original out-of-pocket expense of 450
Reimbursement of 150 ((75-25)*3)
Net therapy cost incurred by the client, 100 per session (450 debit, 150 credit)