Insurance & Billing

LFWC accepts many types of insurances. Most types of insurance have mental health coverage. We are happy to check your coverage for you before your treatment begins.

At this time LFWC cannot accept Anthem Blue Cross Blue Shield of Wisconsin Health Care Exchange insurance. The network is not accepting any provider additions. We will keep you posted as to when or if we are accepted into the network.

Cost is dependent upon your deductible, co-pays/coinsurance, service type (e.g. individual, group, testing) and your provider. Services provided by psychologists are billed out higher than by master’s level counselors.

If you do not wish to use your insurance or have inadequate or no coverage, please inquire about out of pocket rates.

Please Note:
Client related work that may not be covered by insurance will be billed to you at a prorated hourly rate. Included for charges are the following:

  • Extended telephone time (beyond 5 minutes)
  • Consultation with school professionals, employers, family members, and other professionals as requested by the client
  • Report preparation
  • Lengthy correspondence
  • If you are unable to keep an appointment we would appreciate 24 hours notice. If there is no cancellation of an appointment and you fail to show, you will be billed at the normal rate. This is an unfortunate occurrence that we wish to avoid.
  • It is our policy to be as responsive to you as possible, particularly during times of crisis. Though psychotherapy is not as effective over the phone, sometimes it is necessary to intervene in this way. Please be advised that crisis calls requiring intervention will be billed on a prorated basis at the normal hourly charge.

Feel free to ask questions about your bill and our billing policies! Call us at 262-695-8857

 

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What do I need to know about my insurance benefits?

Dealing with insurance plans can be challenging, especially when you are already stressed and worried about mental health issues you or a loved one are experiencing. For this reason, it is best to understand your benefits before you need to use them, if at all possible. The following are steps you can take to make sure you understand your benefits so that you can do whatever is within your control to have your treatment covered.

Reviewing Your Insurance Policy
The first thing to find out is what mental health benefits your insurance policy offers. Review your insurance policy so that you are clear about whether your policy includes coverage for mental health services, types of services that are covered and the amount paid for these services, and any steps you must take to have treatment covered. You should have received a copy of your insurance policy when you enrolled in the program, whether at work or independently. If you did not receive a copy of the policy or have lost yours, you can call your insurance company and ask for another one to be sent to you.

Even if you have a copy of the plan, it is always helpful to speak to someone else and clarify questions. This way you can identify any possible points of confusion before you receive a bill. You should have a number on your card or on the website that will tell you whom to contact.

The following are some questions you will want to ask your insurance company, if possible, before starting treatment:

  1. Do I need a referral from my primary care physician to a mental health professional?
    Many insurance companies, especially Health Maintenance Organizations (HMOs) require referrals from a primary care physician to visit any specialist, including mental health professionals. If you do not receive a referral before visiting a mental health professional, your insurance company may deny your claims. If you think you require a referral, you should always get it in advance.
  2. Do I need any pre-approval from the insurance company before I see a mental health professional?
    A referral is an authorization from a doctor saying that the treatment is medically necessary; pre-approval or pre-authorization­ requires that your insurance company agrees to make the payment. You should call your insurance company to see if you need pre-approval, but you should also keep other questions in mind-how many visits are you approved for? Do you need a new approval for each visit? If you are going to be hospitalized or in inpatient care, how many days are you allowed to stay?
  3. Do I need to see a mental health professional who is on a list provided by my insurance company (in a “network”) or am I free to choose any qualified professional?
    If you need an “in network” provider, you can usually find a directory online or ask your primary care physician to help pick someone out.
  4. Does the amount paid by my insurance company depend on whether I see a professional who is “in their network or preferred provider list” or “outside the network”? If so, what is the difference in the amount paid or percent reimbursement for “in network” vs. “out of network” providers?
    “In network” providers are almost always cheaper than “out of network” providers, although whether you want to save money or visit a doctor you prefer is a choice you will have to make. Bear in mind that your insurance company may not always have a flat difference. For some companies, seeing an “in network” provider may cost you a $20 co-pay, and an “out of network” provider will cost you $30; in others, “in network” may cost you $20 and an “out of network” may cost you 20% – which could be significantly higher than $30.
  5. Are there dollar limits, visit limits or other coverage limits for my mental health benefits? Is there a difference in what is paid for outpatient vs. inpatient treatment? If so, what are my benefits for each of these?
    It is not uncommon, based on your state and your plan, to have limits on psychiatric visits or medication management visits. Your plan may limit you to something like 25 sessions with a psychiatrist each year, up to 7 days of inpatient treatment a year, and 12 medication management visits a year. If you exceed these services, you will have to pay out of pocket.
  6. Is there a specific list of diagnoses for which services are covered? If so, is my diagnosis one of those covered by my policy?
    Insurance companies often have the option to not include certain diagnoses in all policies. If you applied with your condition as a pre-existing condition, they may not cover anything related to that. Your insurance company will provide you with a list of covered and uncovered diagnoses.

Understanding the Terminology

Deductible
A deductible is the amount you pay for health care services before your health insurance begins to pay.

If your plan’s deductible is $1,500, for most services, you’ll pay 100 percent of your medical bills until the amount you pay reaches $1,500. After that, you share the cost with your plan by paying coinsurance and copays.

Co-insurance
Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the total charge for the service. You start paying coinsurance after you’ve paid your plan’s deductible.

Once you’ve paid your $1,500 deductible, your plan will cover a contracted percentage of the cost of your medical care. You pay the remaining percentage, that’s coinsurance.

Co-payment
A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service.

A contracted amount for a therapy session, such as $30. The copay for an intake (initial session) will sometimes cost more, such as $50. It is possible to have both a copay and coinsurance.

In-Network vs. Out-of-Network
What do these terms mean? And how do they affect how much you have to pay for your care?

The providers at LFWC contract with a number of insurance companies. Not all the providers contract with all companies so be sure to check if your provider is in your “network.” In network providers have agreed to accept your plan’s contracted rate as payment in full for services.

That contracted rate includes both your insurer’s share of the cost, and your share. Your share may be in the form of a co-payment, deductible or co-insurance. For example, your insurer’s contracted rate for a a one hour therapy session might be $120.  If you have a $20 co-payment for therapy visits, you will pay $20 when you see a doctor in your network.  Your insurer will pick up the remaining $100. (after applicable deductibles are met)

Out-of-network providers are not contracted with your insurance company. You will likely pay more if you choose an “out-of-network” provider. That’s because:

  • Providers outside your network have not agreed to any set rate with your insurer, and may charge more.
  • Your plan may require higher co-pays, deductibles and co-insurance for out-of-network care. So, if you normally have to pay 20% of the cost of the service in-network, you may have to pay 30% out-of-network. Often, you’ll have to pay that PLUS any difference between your insurer’s allowed amount and what the provider charges.
  • Your plan may not cover out-of-network care at all, leaving you to pay the full cost yourself.

Out of Pocket
If you do not wish to use your insurance or have inadequate or no coverage, please inquire about out of pocket rates.

Contact Us

Lakefront Wellness Center, S.C.

Phone: 262-695-8857
Fax: 262-695-8879

lakefrontwellnesscenter@outlook.com

Hours

REGULAR BUSINESS HOURS:
Monday through Thursday
9am to 5pm

Evenings, Friday and Saturday:
Limited availability of some Therapists, call for more information
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