Insurance Coverage: What your insurance will pay for—this includes the types of treatments, therapies, and providers that your insurance plan will help pay for. Coverage doesn’t mean your insurance will pay for the entire cost of your care. It simply refers to what types of services your insurance will help pay for. You may still need to pay part of the cost, depending on your plan.

Benefits: The mental health services your insurance covers, like how many therapy sessions you can have or what type of treatments are included.

Coordination of Benefits (COB) Denial: A denial from your insurance company or companies wanting you to contact them and complete a short questionnaire about coverage. To complete a coordination of benefits please contact your insurance company or companies to complete the coordination of benefits and then contact River Valley so that we may reprocess your claims. Failure to do so risks issues and making you responsible for all balances owed.

IMPORTANT: Please let us know if any of your insurance information has changed. Any delay in notifying us may result in you (the guarantor) being responsible for the balance of each session.

Contractual Allowance: The difference between the amount charged for a service and the amount that is allowed for the service by the insurance company.

Copay: A fixed amount you pay for a service. Example: $20 copay for a therapy session. You pay this amount at each visit.

Coinsurance: The percentage of the cost you pay after meeting your deductible. For example, if your insurance covers 80%, you pay the remaining 20%.

Deductible: The amount you must pay out-of-pocket for services before your insurance starts covering costs. For example, if your deductible is $500, you pay that amount before insurance kicks in.

Max Out of Pocket: The most a client pays for covered services within a plan year.

In-Network: Providers (like therapists or doctors) that have agreements with your insurance, meaning they accept your plan and you pay less out-of-pocket.

Out-of-Network: Providers that don’t have agreements with your insurance. You may have to pay more for their services, or your insurance might not cover them at all.

Credential: Not all providers are legally allowed to accept all insurances. They have to be credentialed with that insurance. If you change insurance, make sure your provider is credentialed with that insurance. If they are not, you will be responsible for the balance of each session.

Mental Health Coverage or Behavioral Health Services: Make sure your plan has coverage for the service(s) we are providing.

Client Responsibility: It’s your responsibility to understand your insurance plan and benefits.

• Contact your insurance company to find out what services are covered and what costs (copays, deductibles, coinsurance) you may owe.
• River Valley cannot legally explain your insurance benefits or predict your costs after your claim is processed.
• To know your exact costs, always check with your insurance provider directly.

We highly encourage all clients to contact their insurance companies and learn about their plan’s individual benefits. Here are some of the best questions to ask:

• What is the term for your benefits?
• Which disorders fall under mental health?
• What does it mean if your policy states that you have a set number of days of mental health insurance?
• What is the “patient responsibility” amount of my latest mental health appointment code?