CAS is in-network with all Blue Cross Blue Shield (BCBS) and some United Healthcare Student Resources (UHCSR) plans. CAS accepts all other insurance plans (e.g., Aetna, Beacon Health Options, Cigna, Optum, Meritain Health, Tufts, United Healthcare) as an out-of-network provider so long as the plan offers out-of-network benefits.
HMO stands for Health Management Organization. These plans will only cover the cost of services with an in-network provider, which means your provider must be contracted with your insurance company. The only HMO plan accepted by CAS is Blue Cross Blue Shield (BCBS). If you have an HMO plan other than BCBS, CAS can offer you a self-pay arrangement, but will be unable to accept your insurance plan as an in-network provider.
PPO stands for Preferred Provider Organization. Most PPO plans permit you to choose any provider, including providers who are not “in network” (contracted) with your insurance company. CAS can accept any PPO plan. If you have a Blue Cross Blue Shield (BCBS) PPO plan or certain United Healthcare Student Resources (UHCSR) PPO plans, CAS will accept your plan as an in-network provider. If you have any other PPO plan, CAS can accept your plan as an out-of-network provider. In either case, CAS will submit insurance claims and collect reimbursement directly from your insurance company, although you are still financially responsible for any cost-sharing required by your insurance plan, including deductibles, copays, and/or coinsurances.
Your insurance card may indicate if your plan is an HMO or PPO or you can call your insurance company to inquire. Our intake coordinator can also call your insurance company on your behalf to determine if you have an HMO or PPO plan.
CAS accepts all Blue Cross Blue Shield student health insurance plans and United Healthcare Student Resource plans issued by Boston College and Tufts University as an in-network provider. CAS accepts all other all other university student health insurance plans as an out-of-network provider. Upon request, we may be able offer college students a sliding scale to align with the fees they would be charged if services were obtained from an in-network provider.
Each insurance company (and even each insurance plan within the same insurance company) requires different cost-sharing fees, based on your individual plan. “Cost-sharing” means you share the cost of your mental health services with your insurance company and includes deductibles, copays and/or coinsurances. Our intake coordinator will contact your insurance company to determine the required cost-sharing fees for your plan. These fees represent an estimate of your fees for services at CAS, which will be shared with you prior to scheduling an intake appointment. CAS can only provide an estimate of your fees based on the information provided by your insurance company. Exact fees cannot be determined until your insurance company processes your insurance claims.
A deductible is a specific dollar amount you are required to pay before your insurance begins to cover the cost of mental health services. Deductibles can vary widely, ranging from hundreds to thousands of dollars. Deductibles renew annually when your insurance policy renews, meaning you are responsible for paying the deductible anew each policy year. Policy years do not necessarily correspond to a calendar year so, if you have a deductible, contact your insurance company to inquire when your policy year renews. Your deductible will accrue across your different medical providers. For some insurance plans, deductibles apply to both in-network and out-of-network providers, while for other plans, deductibles only apply to out-of-network providers. This means you may have paid a portion of your deductible to other providers by the time you begin services at CAS. Our intake coordinator will contact your insurance company to determine if you have a deductible, but you should contact your insurance company to inquire if you have already paid any portion of the deductible in the current policy year, as insurance companies may not provide this information to anyone other than the client.
A copay is a specific dollar amount your insurance requires you to pay per service. A coinsurance, on the other hand, requires that you pay a specific percentage of the fee per service.
Balance billing occurs when a client is billed the difference between the fee allowed by an insurance company for a specific service and the provider’s standard fee for that service.
Balance billing is not permitted when you receive services from an in-network provider because the fees have been predetermined and agreed to between your provider and insurance company in their contract. This fee may differ from the provider’s standard fee, but the provider cannot bill you for this difference because the provider has agreed to bill you the predetermined fee in their contract with your insurance company.
Balance billing applies when you receive services from an out-of-network provider. Your insurance company will approve a maximum fee for a specific service, known as an allowed amount, which includes your copay, coinsurance and/or deductible. Allowed amounts vary widely from insurance company to insurance company and even across different policies within the same insurance company. Allowed amounts are usually less than the provider’s standard fees. In addition to your deductible, copay and/or coinsurance, you are responsible for the difference between the allowed amount and your provider’s standard fee for a specific service. Therefore, your fees for a service may include deductibles, copays and/or coinsurances and, if your insurance company’s allowed amount is less than the provider’s standard fee, balance billing fees.
Our intake coordinator will contact your insurance company to inquire about your deductible, copay and/or coinsurance, as well as the allowed amounts for your services. Some insurance companies will disclose allowed amounts to providers, while others will not do so. If your insurance company will not disclose its allowed amount, CAS will reference other claims paid by the same insurance company to estimate the allowed amount. Even if your insurance company discloses the allowed amount, your exact fees cannot be determined until your insurance company processes insurance claims for your services, as allowed amounts can change monthly, quarterly or annually. Therefore, CAS can only provide you with an estimate of your fees.
Processing times for claims vary from insurance company to insurance company. Many insurance companies process claims within 30 days of the date they receive the claims, but some take longer. CAS generally submits claims on a weekly basis, but it may take up to 30 days to submit a claim for a particular date of service or longer if CAS has not received accurate billing information. Insurance companies sometimes require CAS to resubmit claims that were not properly processed by the insurance company for a variety of administrative reasons. If you have questions about a specific claim, contact your insurance company to request an Explanation of Benefits (EOB), which should be made available to you by your insurance company via mail or online for each processed claim.
Our fee is $250 per session for self-pay arrangements.
Our Postgraduate Social Work Fellows offer a limited sliding scale. Contact our office for details.
See the Massachusetts Consumer Guide to Understanding Health Insurance: