In Network Providers
Herb + Ōhm is an in-network provider with BCBS. As part of our in-network agreement with this provider, we will verify acupuncture benefits, file claims, and facilitate the processing of claims on behalf of all in-network patients. An administrative fee is built into our service rates, which we bill to your insurance provider for the time it takes to submit claims and collect payment.
Out of Network Providers
Upon request, Herb + Ōhm will provide a superbill to patients with out-of-network coverage. Patients may directly submit these superbills to their insurance company for potential reimbursement. Please note: Out of network insurance providers cover a limited number of diagnoses related to acupuncture. There is no guarantee that your insurance company will cover your diagnosis even if you ultimately have acupuncture coverage.
In-network Insurance Payments and Policies FAQ
Why is my amount due per treatment more or less than your cash rate while I pay my annual deductible?
Herb + Ōhm’s cash rates include a time-of-service discount because payment is received in full at the time of service.
To become an in-network provider, Herb + Ōhm has established contracted rates with each in-network insurance company. These rates differ by insurance carrier and include an administrative fee for the time it takes to verify benefits, file claims, facilitate claim processing, and await payment. The total you pay Herb + Ōhm toward your deductible will never exceed the amount of your annual deductible. Each insurance company simply structures the deductible rate of payment differently.
Why are the total billings on my EOBs different than your cash rates?
Herb + Ōhm’s cash rates include a time-of-service discount because payment is received in full at the time of service. To become an in-network provider, Herb + Ōhm has established contracted rates with each in-network insurance company. These rates differ by insurance carrier and include an administrative fee for the time it takes to verify benefits, file claims, facilitate claim processing, and await payment.
What if I meet my deductible with a different medical provider?
We do our best to track your deductible from the amount you pay in our office. If you are seeing other medical providers and meet your deductible before it is met at our office, please notify us so that we may begin applying your copay or coinsurance in the future.
What happens after I meet my deductible? How much will I owe per treatment?
The deductible is how much you pay before your insurance starts paying. Generally, if you haven’t met your out of pocket maximum, you will owe a copay or a co-insurance amount per treatment once you’ve met your deductible. These amounts will vary based on your individual insurance policy.
What’s the difference between co-insurance and a copay?
Co-insurances and copays are a form of cost sharing for health services between insurance companies and subscribers (you). A copay is a flat fee, while a co-insurance is a percentage of the cost for a health service paid by a member after they have reached their deductible. Co-insurance amounts vary by insurance carrier and policy. Upon request, our front desk team can provide you with an estimate of your coinsurance per treatment for an initial and follow up visit.
What is an out of pocket maximum?
An out of pocket maximum is a predetermined limited amount of money that an individual must pay before an insurance company will pay 100% of an individual’s healthcare expenses for the remainder of the year. If you know you have met your out of pocket maximum, please notify our office and we will no longer apply a copay or coinsurance to your future treatments.
I don’t know whether I have coverage at the time of my acupuncture treatment. If I pay cash for my initial treatment today and find out I have insurance coverage for acupuncture, can you retroactively apply my insurance to the treatment?
Yes. Depending on your coverage, this situation may result in additional funds owed toward your deductible or a credit that can be applied toward future copays/coinsurances or deductible amounts. Please note: we will only retroactively apply your insurance toward your initial treatment if your insurance status is pending at that time. We will not retroactively apply your insurance if you notify us that you’d like to use insurance after receiving multiple treatments.
I have a certain number of covered visits per year on my policy. What if I receive more than my allotted visits per year?
While Herb + Ōhm does its very best to track your number of visits and notify you once you are approaching your last covered visit, should you exceed your maximum covered visits per year, you will owe a balance equal to our cash rate for the uncovered visits.
