Insurance

Hill Country Anxiety is regularly looking for opportunities to make our services more available to clients by partnering with other healthcare organizations and insurance panels. Dr. DillonDr. Cavazos, and Megan Daniele are now accepting Aetna and United Healthcare (including Optum) insurance plans through our third-party insurance billing partners, Headway and Alma.

These companies allow us to provide more affordable access to individual and family therapy services billed under specific medical codes for policy holders who choose to use their insurance benefits for these services. Below are the CPT codes for time based therapy services available for Hill Country Anxiety patient sessions through Headway and Alma:

  • 90791 – Patient Diagnostic Session
  • 90834 – Patient Session (45 Minutes)
  • 90837 – Patient Session (60 minutes)
  • 90846 – Family Session with Patient (30 Minutes)
  • 90847 – Family Session without Patient (30 Minutes)


All other services will be billed as private pay through our EHR System, Jane, unless prior arrangements have been agreed upon with Hill Country Anxiety administration. 

Insurance Plans on Headway & Alma

These billing platforms accept a number of Insurance Plans for covered services. Below is a list of health plans that our clinicians are currently accepting on each platform; accepted health plans may change periodically and we will attempt to confirm benefits and eligibility prior to each session:

Headway Billing Platform

The Headway Insurance Program currently includes the following insurance plans:

    • Aetna

Alma Billing Platform

Optum is inclusive of a number of health plans included in the Alma Insurance Program:

    • United Healthcare Shared Services (UHSS)
    • GEHA – UnitedHealthcare Shared Services (UHSS)
    • UnitedHealthcare Global
    • UnitedHealthCare Exchange Plans (ONEX)
    • Oscar
    • Harvard Pilgrim
    • Oxford
    • UHC Student Resources
    • UMR
    • All Savers (UHC)
    • Health Plans Inc
    • Surest (Formerly Bind)

Some notable exceptions and conditions for using your plan benefits on these billing platforms:

    • Only Primary Insurance plans are accepted – Policy holders should contact their health plans to confirm ‘coordination of benefits’ for the patient and ensure that the necessary plan is set as primary with all insurance plans.
    • Medicare, Medicaid, CHIP, STAR, and other state or federal plans are not accepted
    • Not all plans provided by these Insurers will be accepted as there may be exceptions or ‘carveouts’ that are specific to an individual plan.

 

In all cases, Patient eligibility and benefits will be confirmed after registration/onboarding process is completed and periodically throughout the treatment process. Please notify your clincian or contact our billing staff if you have changes to your insurance policy. 

Hill Country Anxiety clinicians are considered “Out-of-Network” providers for all other health plans and they do not currently accept Medicare, Medicaid, CHIP, Star, or any other state/federal plans. All session fees are collected at the time of service. 

Please review the information below for more details about Out-of-Network benefits, Superbills, and Good Faith Estimates.

Out-of-Network Benefits

Some insurance plans provide coverage or reimbursement for partial or full costs of treatment. We encourage you to review your insurance plan benefits to determine what out-of-network behavioral health coverage may be available to you and if prior authorization is required to use those benefits. Please note that not all insurance companies reimburse for visits to out-of-network providers and below are some recommended questions to ask when you contact your insurance plan provider or plan administrator*:

  • What “Out-of-Network Benefits” are included with my plan?
  • Do I require “Prior Authorization” to see an out-of-network provider for mental or behavioral health services?
  • What are my deductible and co-insurance costs for “Mental or Behavioral Health” coverage?
    1. In office
    2. Telehealth
  • What are my plan’s allowed amount and reimbursement rate for the following medical billing codes when ‘Out-of-Network’? (Note: these represent our commonly billed codes but are not an exhaustive list)
    1. New Client Diagnostic Session – 90791
    2. Therapy Sessions – 90834, 90837, 90846, 90847 
 
* Insurance coverage and plan benefits for Mental and Behavioral Health services are sometimes administered by a third-party contracted by your Insurer or Plan sponsor (i.e. Employer). When contacting your Insurance Company or Plan, ensure that you remind the person(s) you speak to that you are checking on Mental or Behavioral Health benefits to help them get your call to the right place, hopefully on the first attempt.

Superbills

Hill Country Anxiety provides a Superbill to each of our clients that pay out-of-pocket for the qualified medical expense. A Superbill is a receipt for a paid session with an out-of-network clinician allowing the client to submit to their health insurance for credit or reimbursement if benefits are available. Reimbursement is determined by the individual healthcare policy at the time the claim is received based on the dates of service and services provided. 

What’s in a Superbill?

A Superbill is a statement of service(s) from a clinic or clinician that includes all of the details required by the insurance providers to determine coverage for services. The statement reflects the date(s) of service (DOS), the service code or CPT code, the diagnosis code(s) and the billed amount from the rendering provider, along with the clinician’s credentials.

Good Faith Estimates and the No Surprises Act

Under the No Surprises Act, clients who are seeking out-of-network services are entitled to receive a “Good Faith Estimate” of how much their care will cost, prior to receiving care. The good faith estimate is not a bill.

  • The “Good Faith Estimate” is a notification that outlines an uninsured (or self-pay) individual’s expected charges for a scheduled or requested item or service.
  • The estimate is based on information known at the time the estimate was created. As such, due to an individual’s treatment needs, depending on the complexity and severity of presenting issues as well as the degree of personal investment towards improvement, the duration of treatment may vary significantly. We will provide an estimate for an average annual cost of care.
  • If you receive a bill that is at least $400 or more than your Good Faith Estimate, you can dispute the bill. There’s a $25 non-refundable administrative fee to start this process.
  • Make sure to save a copy of your Good Faith Estimate, which can also be accessed via your Client Portal.
  • For more information about the No Surprises Act, you can visit www.cms.gov/nosurprises or call 1-800-985-3059.