Niva Health

Now Accepting Insurance

Now Accepting Insurance

Understand Your
Insurance Coverage

Insurance is hard to navigate. Here is a helpful guide on frequently asked questions regarding insurance for our services. Often, these are covered differently than your typical doctors’ appointments. 

What Insurance Networks Are Accepted by NIVA Health?

Providers with NIVA Health currently accept a wide variety of health insurance. Coverage depends on your region. 

If your insurance isn’t accepted yet, keep an eye out. We’re consistently looking to add new partners to bring affordable care to everyone. In the meantime, many NIVA Health providers offer cash-pay as an option.

How Do I Contact My Insurance Company?

You should see a “Members Services” or “Customer Service” number on your insurance card. The number is typically on the back of your card. When speaking with your insurance, be prepared to share your ID number, name, date of birth, and social security number.

Common terms explained

A copay is a fixed cost per service. If your plan states that the visits are subject to a copay, sessions will cost the same, regardless of the CPT code(s) billed by your provider following your appointment(s).

ⓘ Definition: The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting and increase accuracy and efficiency.

A copay is a fixed cost per service. If your plan states that the visits are subject to a copay, sessions will cost the same, regardless of the CPT code(s) billed by your provider following your appointment(s).

ⓘ Definition: The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting and increase accuracy and efficiency.

A deductible is the amount you pay for health care services before your health insurance begins to pay. Plans can have an individual deductible that must be met by the individual seeking care or a family deductible for all plan members to meet collectively. Deductibles typically reset every year or when starting a new plan.

ⓘ How it works: If your plan’s deductible is $1,500, you’ll pay 100 percent of eligible healthcare expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance.

Coinsurance is your share of the costs of healthcare services. It’s usually figured as a percentage of the amount the insurer allows to be charged for services. You start paying coinsurance after you’ve paid your plan’s deductible.

Coinsurance payments continue until the end of the plan period or until you’ve hit the out-of-pocket maximum/limit.

ⓘ How it works: You’ve paid $1,500 in health care expenses and met your deductible. When you receive additional care, such as a doctor’s appointment or therapy session, instead of paying all costs, you and your plan share the cost.

For example, if your plan pays 80%, the remaining 20% is your coinsurance. A $100 visit with a NIVA Health provider would result in $80 covered by your insurance provider, with you being responsible for the remaining $20 out of pocket.

Your out-of-pocket maximum/limit is the most you must pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.

The out-of-pocket limit doesn’t typically include the following:

  • Your monthly premiums (i.e., the recurring payment to your insurer for coverage)

  • Anything you spend for services your plan doesn’t cover

  • Out-of-network care and services

ⓘ How it works: If your limit is $7,500 and you spend this much on services throughout the year, your insurance will cover 100% of the costs after that. No additional coinsurance payments are required.

Coverage concerns

If you are covered by multiple insurance plans, please confirm with your primary insurance that they have your secondary insurance plan on file by requesting to update your Coordination of Benefits (COB). Many insurance companies will only reimburse you if you report your secondary insurance.

Also, please remember to send a copy of your secondary health insurance card to NIVA Health to avoid being charged under your primary benefits only.

If you are covered by multiple insurance plans, please confirm with your primary insurance that they have your secondary insurance plan on file by requesting to update your Coordination of Benefits (COB). Many insurance companies will only reimburse you if you report your secondary insurance.

Also, please remember to send a copy of your secondary health insurance card to NIVA Health to avoid being charged under your primary benefits only.

If your plan does have out-of-network benefits, you will be charged along those benefit guidelines.

If your plan is out-of-network and you do not have any out-of-network benefits, you will be billed at your provider’s self-pay rate. You can request an invoice, also known as a superbill, from your provider for you to submit to your insurance for reimbursement. Self-pay visits do not count toward an insurance deductible.

Explanation of Benefits

A few weeks after a session, you may receive an Explanation of Benefits (EOB) document from your insurance company. This looks like a bill, but it isn’t. Instead, it outlines and explains the services you received.

A copay is a fixed cost per service. If your plan states that the visits are subject to a copay, sessions will cost the same, regardless of the CPT code(s) billed by your provider following your appointment(s).

ⓘ Definition: The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting and increase accuracy and efficiency.

An explanation of benefits (EOB) is sent to you by your health insurance company to inform you that a claim has been processed for the care you received. It’s meant to help you understand how much each service costs, how much your plan will cover, and typically how much you may have to pay when you receive a bill. EOBs should help clarify the following:

  • The cost of the care you received

  • What portion of the cost your insurance company covered, including special member discounts or preferred member rates

  • Any out-of-pocket expense you may be responsible for

The EOB is not a bill. It simply reflects how your insurance processed your claim. You do not need to take any action on your EOB.

An EOB includes a charge rate from NIVA Health. The charge rate is the highest amount on the EOB and is typically listed under Amount Billed. This charge rate, a.k.a. billed amount, is not your responsibility.

Once your claim is processed, you will only be charged the amount you owe if anything at all. Your cost may be $0. This is typically your copay or coinsurance rate. You will be charged the full member rate if you have a high-deductible plan and still need to meet your deductible.

After each session, a claim that includes the “charge rate” between $180-350 is automatically sent to your insurance company for processing. Processing typically takes 3 to 4 weeks, after which the insurance company will send you an EOB. An EOB shows how much of the insurance rate, aka member rate, will be split between you and the insurance company.

In the example below, the session cost totaled $162, and the insurance company states they will cover $122 of it while you are responsible for a $40 copay. Grow Therapy would charge $40 to your payment method on file.

After your first claim is processed, you’ll know your cost per session. Depending on your plan, you could be charged a copay, coinsurance, or towards your deductible. Each plan has its own benefit guidelines.

If you’re charged towards your deductible, this will continue until it’s met. After that, you’ll either pay a copay or coinsurance. If you’re charged a copay or coinsurance, you’ll pay that amount until your out-of-pocket maximum is reached, after which you won’t be charged.

This video by Kaiser provides a great overview. Remember, if you have a deductible-based plan that resets at the beginning of the year, you may be charged the full member rate until your deductible is met.

We Accept Many Major Insurances Including

BUT NOT LIMITED TO:

With NIVA Health’s commitment to excellence and personalized care, you can trust that you are in capable hands as we guide you on your journey to better health and vitality. Experience the difference that tailored, high-quality healthcare can make in your life at NIVA Health. Contact your Local NIVA Health Office or request an appointment.