Using Medical and Mental Health Insurance to pay for Mental Health Services
Believe to Achieve Wellness, LLC may be In Network if you have Aetna, Anthem Blue Cross Blue Shield, Medical Mutual, Oscar, Oxford Health Plans, Summa or United Healthcare.
Determining the Cost of Therapy
List of Questions to Ask your Insurance Provider
This list of questions is not intended to be comprehensive; it simply provides guidance to maximize your time with your insurance company and set budget expectations.
☐ Do I have mental health or behavioral health benefits? These could differ from regular medical benefits.
☐ Is Believe to Achieve Wellness IN NETWORK or OUT of Network?
If asked, you can provide the following NPI 1# 1891242996 or Group NPI# 1215636584.
☐ Do I have an In Network deductible? If Believe to Achieve Wellness is Out of Network, what is my deductible? How much is it and how close am I to meeting the deductible?
☐ Do I have co-insurance? What is the co-insurance percentage per session (after meeting the deductible)? Do I have co-insurance and when does that kick in?
☐ What is my copay for behavioral health? Does the co-pay start after I meet my deductible?
☐ Which costs re-start each January 1st?
☐ Do I need a referral? Ask if your insurance provides an authorization code that you may then provide to your therapist.
☐ Please note the name of the insurance representative, date and time of call. Email kmetzler@b2awellness.com the following:
Verification of Benefits – B2AW is IN or OUT of Network
Co-pay:
Deductible:
Co-insurance %:
Use of a HSA and/or FSA:
Key changes to know for this year:
Out of Network
At your request, B2AW can email a Superbill for you to submit to your insurance company for Out of Network (OON) benefits. To learn your OON benefits and deductible amounts which typically re-start each January 1st, please contact your insurance company.
NOTES
- It is each prospective and current client’s responsibility to verify their insurance benefits with their insurance company directly using the following info from Believe to Achieve Wellness: NPI # 1891242996 and Tax ID: 85-1222623. As soon as clients are informed of a change that may affect their insurance benefit coverage or process such as a name change (marriage, adoption divorce, etc.), other change in insurance benefits or change to a new insurance company, it is the client’s responsibility to inform Believe to Achieve Wellness of the expected change and the expected date of the change BEFORE the change occurs so benefits can be re-verified by the client and Believe to Achieve Wellness, LLC again. More info on how to verify benefits is on the B2AW Financial Policies document at the bottom of the home page or by clicking here.
- Even if you have one of the insurance companies above, please check if you have a separate card or policy for Behavioral Health or Mental Health benefits. Your appointments will need to be billed under that 3rd party (i.e. UNITED HEALTHCARE) not your primary medical insurance company (i.e. Medical Mutual).
- Effective 5/1/25, Believe to Achieve Wellness will no longer be accepting Cigna as an In Network provider. If you have Cigna and would like to begin working with Kay Metzler, please consult with your specific Cigna insurance provider and inquire about potential Out of Network benefits.
- The following may not be covered by your insurance and may revert to the Private Pay Fee Schedule:
- Coordinated care with parents, doctors, psychiatrists or school teams
- More than one appointment in a day or week
- Interim care via phone calls, faxes, correspondence and unplanned meeting requests between sessions
KEY POLICIES
Cancellation Policy:
- To respect your time and your therapist’s time, please notify your therapist as soon as you know of any potential conflict. The cancellation fee for regular therapy sessions is $100 & $120 for a cancelled ART session. If a session is canceled less than 2 full BUSINESS days in advance, the Cancellation Fee is assessed within 1 business day. Please cancel before Monday 8 AM for a Wednesday appointment. Please cancel before Thursday 8 AM for a Monday appt the following week.)
- A list is kept for current clients who may need an extra session. Nearly all openings fill up quickly each week.
- Exceptions are made for sudden and unexpected situations. If you suspect you have any potentially contagious symptoms, PLEASE inform your therapist and do NOT come to your counseling session in person. For example, even if the parent transporting a client is ill and your child has no symptoms, your therapist would still prefer to switch your appointment to a remote visit or if you are too ill, the appointment will be canceled. A fee will NOT be assessed if you are protecting your therapist and other clients from any potential symptom transference and diligently communicate with your therapist about an alternate appointment that same week.
Fee Schedule Updates Clients will be given notice of any significant updates to the Fee Schedule.
Session Environment:
- Only the primary client(s) can be present (with a parent or guardian often invited to “check in/check out” with the therapist for minors). Please inform your therapist if your session will begin late. If the session time becomes less than 30 minutes, we will likely need to reschedule.
- Laws are in place to ensure confidentiality and your safety. Please do not attempt to conduct any portion of your therapy while driving or while in a moving vehicle.
- Insurance requires your therapist to note your location and for you to be in the state of Ohio during the time of your counseling session. Please cancel any appointments as soon as you know you will be physically located out of the state.
- Please secure a confidential space with no expected interruptions. (Please inform family members or roommates that you should not be interrupted for your weekly time focused on YOU.)
