Understanding Your Mental Health Insurance

Tranquil Life Counseling Center’s clinicians are members of most private and Medicaid managed care insurance panels. Our administrative staff will verify whether or not we partner with your insurance plan at the time of your first call. Tranquil Life Counseling Center participates with the following major insurance companies:

When you call Tranquil Life Counseling Center for your initial phone inquiry, the administrative staff will ask you for your insurance information and confirm if we are in network with your provider. Tranquil Life Counseling Center administrative staff will utilize our electronic health record to send you our consent packet which can be reviewed, signed and completed electronically. Once all of the demographics information, insurance information and the intake questionnaire have been completed and a picture of the front and back of your insurance card has been uploaded, our staff will verify your insurance benefits. Please note that we do require a credit card on file for every client.

Our administrative staff will make every effort to determine accurate benefits information, however at times our resources are not able to give full details of what your portion of the payment will be. We encourage you to contact your insurance company to verify your payment as well.

Our administrative staff will not schedule an appointment until it is determined that you have appropriate insurance coverage or you agree to pay without utilizing your insurance.

Three Basic Types of Insurance Plans for Mental Health Benefits

In planning for payment you should first determine which of the three basic types of insurance plans you currently have. Many of the questions you have will be answered by determining the type of plan you have and verifying your mental health benefit with the Employee Benefits Manager at your workplace or making direct contact with the insurance plan’s Customer Service Representative.

Indemnity Plan

Indemnity plans allow for the insurance payment to go directly to the client or the responsible party for the client. Consequently, the client or responsible party pays in full for the mental health services that are received. The provider of the services provides a receipt that can be submitted to the insurance plan, the client or responsible party then submits the receipt and receives reimbursement from the insurer. With Indemnity Plans there is often a deductible amount that must be paid by the client or responsible party before reimbursement is offered. Indemnity Plans reimburse on Standard Fee for services, allow clients to choose their own counselor, and allow the counselor to determine how many sessions are necessary.

Preferred Provider Organizations (PPO)

PPO plans establish contracts with a group of counselors who are noted as “in-network providers.” The contracts set the fees that in-network providers are allowed to bill. The fees are only paid to the provider and cannot be paid to the client or responsible party. The cost to the client or responsible party may include a deductible and/or co-pay. If the client or responsible party selects an out-of-network provider, the plan may be the same as an Indemnity Plan.

Health Maintenance Organizations

HMO plans operate in a similar manner to PPO plans, however, HMO plans have three unique characteristics. First, HMO plans require that all mental health services are precertifieded by the primary care physician (PCP). Second, HMO plans require that the in-network counselor submit treatment plans to a designated person at the insurance company. The person at the insurance company then determines the necessity for services based on the treatment plans. Third, there is no benefit provided to the client or responsible party if an out-of-network counselor is selected. Like PPO plans, HMO contracts set the fees for in-network providers and the fees are only paid to the provider of services. These plans seldom have a deductible but often require a co-pay. HMO plans generally have lower premiums then Indemnity and PPO plans.

Sliding Scale Fee

If you cannot afford the standard fees at Tranquil Life Counseling Center, and you are ineligible for insurance reimbursement, you may inquire about a reduced fee for mental health treatment. Each individual clinician determines whether or not they allow clients to pay a reduced fee, and what fee is acceptable for their services.