Insurance & Billing

Here & Now is in-network with Aetna, BlueCross Blue Shield PPO, UnitedHealthcare and Medicare. This means that we have a contractual agreement with these companies to accept negotiated rates offered by their plans and collect any balance after insurance processes.

Although we are in-network with these plans, you can still be billed for copays, deductibles, and/or out-of-pocket costs. Once a claim is submitted and processed by your insurance, Here & Now will bill you the applicable fees.

You may wish to call the number on the back of your insurance card to verify what is covered by your plan and what your expected costs will be. Please let us know of any changes to your insurance plan as soon as possible. If your insurance is inactive, or no longer accepted, you will be charged self-pay rates.

For all other insurance plans, we are considered out-of-network. We can provide you with a superbill, which may allow direct reimbursement at out-of-network rates; however, we cannot guarantee coverage of services by your insurance. For out-of-network plans, you will pay Here & Now’s self-pay rates at the time of service. Please note that reimbursement is handled by your insurer, and questions about denials or appeals should be directed to your insurance company.

You can expect to be responsible for the total cost of mental health services at Here & Now, including but not limited to, deductibles, copayments, out-of-pocket costs, late cancellations, and/or missed appointment fees. We require an active credit card on file at all times in order to proceed with scheduling appointments. Our wellness coordinators will assist you in making any pending payments on or before the date of service.

A psychiatric intake is $600, and a psychiatric follow-up is $300. A 60-minute psychotherapy session is $200. Please expect to pay prior to or at the time of service.

At this time, we are not able to accommodate sliding scale rates for psychiatry services. However, you may discuss a sliding scale accommodation for psychotherapy services with your individual therapist.

A superbill is a detailed statement created by a provider that summarizes the services provided during a medical visit. It includes important information like:

– **Diagnosis codes (ICD-10)**: Explains the condition or reason for the visit.

– **Procedure codes (CPT)**: Describes the services or treatments provided.

– **Charges**: This section outlines the cost for each service rendered.

Patients will need a superbill to submit a claim to their insurance company; however, please note that this does not guarantee payment for services rendered from your insurer.

CPT codes and ICD-10 codes play a critical role in a superbill:

– **CPT Codes**: These are used to describe the medical procedures and/or services provided during a visit.  

           ■  For example, a CPT code might indicate a routine office visit, a surgical procedure, or diagnostic testing.

– **ICD-10 Codes**: These are used to describe the patient’s diagnosis and/or condition.

Together, these codes help the insurance company understand both the reason for the visit and the services rendered for accurate processing and reimbursement. 

If a patient is seeking reimbursement for out-of-network care, the superbill is used to submit a claim to their insurance company. Here’s how it works:

1. **Obtain the Superbill**: After the medical/therapy visit, request a superbill from the provider’s office.

2. **Submit to Insurance**: To submit your superbill, contact your insurance company and request to speak with “Member Services” or visit their website for detailed instructions on how to submit a superbill.

3. **Review by Insurance**: The insurance company will review the claim, including the diagnosis and procedure codes, to determine how much they will reimburse based on the patient’s out-of-network benefits.

4. **Reimbursement**: The patient will receive a reimbursement check or an explanation of how much will be paid directly to the provider. The patient may be responsible for any remaining balance.

A superbill and an Explanation of Benefits (EOB) are both important documents in the healthcare billing process, but they serve different purposes:

– **Superbill**: This is provided by the healthcare provider to the patient, summarizing the services rendered during a visit. It contains the diagnosis and procedure codes, along with associated charges, that the provider uses to submit a claim to the insurance company.

– **EOB**: This is provided by the insurance company after a claim has been processed to the patient. It explains how the insurance company has paid (or not paid) for the services. The EOB will show the amount billed, the amount covered by insurance according to your benefits, and any patient responsibility until you fulfill your policy deductible/out-of-pocket for the year. Patient responsibility can include copays, deductibles, and/or coinsurance.

The superbill is used to submit a claim to your insurance, while the Explanation of Benefits (EOB) shows how the claim was processed and any remaining balance. For benefit details, please contact your Member Services.

Payments are made through an encrypted credit card processing system for your convenience. We do not accept cash, check, Zelle, or Venmo.

Please reach out to billing@herenowmw.com or call (847) 653-6184 for all questions related to billing.