💡 Insurance Education & FAQs​​

Q: What does “in-network” mean?
👉 In-network means we have a contract with your insurance company. This usually means lower costs for you (set copays, coinsurance, or deductible rates).
👉 Out-of-network means we do not have a contract. You can still see us, but costs may be higher. We’ll provide a Superbill you can submit for possible reimbursement.

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Q: What’s the difference between deductible, copay, and coinsurance?

• Deductible = The amount you must pay out-of-pocket before your insurance begins paying.

• Copay = A fixed amount (e.g., $20) you pay at each visit.

• Coinsurance = A percentage of the session cost (e.g., 20%) that you pay after your deductible is met.
  👉 Example: If you have a $1,000 deductible and haven’t used it yet, you’ll pay full session cost until you reach that amount.

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Q: What is an out-of-pocket maximum?
This is the “safety cap” on what you’ll pay in a plan year. Once you reach it, insurance covers 100% of covered services for the rest of the year.

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Q: Why does my insurance card say something like Lucent, ClaimDOC, or Marpai?
These are affiliates or third-party administrators (TPAs).

• Your employer may hire these companies to manage benefits.

• Even if your card says “Lucent Health” or “ClaimDOC,” your therapy coverage is usually through Aetna, Cigna, or UnitedHealthcare.
  👉 That’s why we always verify your benefits for you — the card name doesn’t always match the big network name.

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Q: Who handles my insurance billing?
We bill insurance through:

• 🧾 Headway

• 🧾 Tava Health

• 🧾 Alma

👉 You may see one of these names (instead of “North Port Counseling Center”) on your Explanation of Benefits (EOB), portal messages, or insurance correspondence.
✨ These partners also provide secure portals for billing and communication with insurance companies. That’s why your EOB or claim statements may show “Headway,” “Tava,” or “Alma” instead of North Port Counseling Center.

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Q: Do you take Medicare?

• ✅ Yes, we accept Original Medicare (red, white, blue card).

• ✅ We accept UnitedHealthcare / AARP Medicare Advantage (via Headway).

❌ We do not accept other Medicare Advantage plans (Humana, Aetna, etc.).

 

Q: Do you take Medicaid?

• ✅ Yes, we accept Straight/Traditional Florida Medicaid.

• ❌ We do not currently accept Medicaid HMOs/Managed Care Plans (e.g., Sunshine, Simply, Staywell, Humana Medicaid).

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Q: What’s an EAP (Employee Assistance Program)?
An EAP is a benefit your employer may provide, offering a limited number of free counseling sessions. After those sessions are used, your regular insurance (or self-pay) applies.
We accept: Anthem EAP, Confide Enhanced EAP, Resources for Living EAP, and MyGroup EAP.

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Q: What are CPT codes, and why do they matter?
Insurance companies use CPT codes to identify the type of service provided. If you’re filing out-of-network benefits, your insurance may ask for these codes:

• 🏷 90791 – Intake / Initial Assessment

• 🏷 90837 – Individual Therapy, 60 min

• 🏷 90834 – Individual Therapy, 45 min

• 🏷 90847 – Family / Couples Therapy (with client present)

• 🏷 90846 – Family Therapy (without client present)

👉 Clients using Superbills will often need these codes.

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Q: How often should I check my benefits?
We verify your benefits before your first session ✅, but insurance can change:

• New year = new deductible

• Employers switch plans mid-year

• Cards may be reissued

👉 We recommend you check your benefits each January or whenever you get a new card.

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Q: Do you cover telehealth sessions?
Yes! 🖥 All of the insurance plans we accept cover telehealth sessions for clients located in Florida.

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Q: What is a Good Faith Estimate (No Surprises Act)?
If you are uninsured or choose to pay out-of-pocket, you are entitled to a Good Faith Estimate of the costs for services. This protects you from unexpected bills and is part of the No Surprises Act.

 

Q: What happens if my insurance denies a claim?
If your insurance denies a claim:

• We’ll notify you right away.

• We’ll work with you to resolve the denial if possible.

• If the denial cannot be overturned, you’ll be responsible for the session cost.
  👉 We’ll always discuss payment options with you if this happens.

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Q: I have two insurances. How does that work?
We will help you coordinate benefits 🧑‍🤝‍🧑.

• Usually, your primary insurance is billed first.

• Your secondary insurance may cover what’s left.

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Q: How can I confirm coverage myself?
You can always call the Member Services number on the back of your insurance card. When you call, ask:
👉 “Is North Port Counseling Center / Stefanie Kalski, LMHC covered as an in-network mental health provider?”

For your convenience, here are the general Member Services phone numbers:

• 📞 UnitedHealthcare / Optum: 1-866-414-1959

• 📞 Aetna: 1-800-872-3862

• 📞 Cigna: 1-800-244-6224

• 📞 Carelon Behavioral Health: 1-800-397-1630

• 📞 Blue Cross Blue Shield of Massachusetts: 1-800-262-2583

• 📞 AvMed: 1-800-882-8633

• 📞 Medicare: 1-800-633-4227

• 📞 Florida Medicaid: 1-877-254-1055

✨ Tip: Always have your insurance card ready — they’ll usually ask for your Member ID when you call.

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✨ Closing Note:
Insurance is complicated, even for us as providers! Please don’t stress — we verify your benefits before your first session and will walk you through what to expect.