All About Insurance

We are here to help!

As you might have read on our homepage, Twin Lakes Counseling exists to make transformative therapy accessible to individuals and families in the Federal Way community and to all of Washington State. Our vision of success is when every person in Federal Way has access to a therapist. We know therapy is too expensive for many. This is why we work so hard to be in-network with as many insurance companies and plans as possible.

The first step in getting started with us is through our Let's Begin page. Below is some additional information about how using your insurance with us works along with some frequently asked questions. In addition, because we know how complicated insurance is, check out our Blog which covers what you need to know to understand how insurance works!

How does insurance billing work?

Step 1: Insurance Verification

Using the information you provide through our Let's Begin page, our team verifies your coverage, benefits, and the existence of a deductible and/or copay/coinsurance.

Step 2: Initial Visit

Once your insurance coverage is verified, your intial visit will be scheduled. This visit will include an overview of your anticipated fees, payments, and our 48 hour cancelation and "no-show" policies. 

Step 3: Claims Submission

After your initial visit, we send in your first insurance claim based on the information you have provided and we have verified. 

Step 4: Wait

Insurance companies have approximately 6 weeks to return claims either accepted or denied. This means we may not be made aware of any issues during that time.

Step 5: Assess Returned Claim

A claim can be returned as accepted or denied/rejected and provides us with a more "official," or at least realistic, look into your coverage. Most of the time it is returned as is expected, but sometimes the covered amount is different. 

Step 6: Continued Billing

Assuming the returned claim comes back with minimal errors, we will continue to bill. It is important to manage and monitor any changes or updates to your insurance and we need your help with this!

Using insurance at TLC

On our "Let's Begin" page there is a list of all commercial and medicaid insurance companies we are proud to be able to accept. We will always need the help of our clients to ensure a smooth experience since each health insurance company has their own complicated way of operating and each of their health insurance plans are unique to the member. For these reasons: 

We need to know all of your insurance plans, including which one is "primary," which one is "secondary," and any other plans that may still be active. You will need to call each of your insurances to determine this since you are the member. We must be in-network with your primary insurance.

If you have Apple Health (medicaid) in addition to another insurance plan, we will send in claims for both insurances but we need to know about both plans! 

We do not send in claims for commercial secondary insurance because they do not pay us. However you may be able to seek reimbursement from your commercial secondary insurance plan on your own as the member. 

Primary versus Secondary Insurance

Not knowing this in the beginning can lead to billing errors and has the potential to result in an unexpected client balance. Primary insurance is the health plan that covers you as an employee, subscriber, or member and is billed first for health care. Secondary insurance is a health plan that covers you in addition to your primary plan and can be billed if your primary plan is exhausted. If you have a primary and a secondary insurance plan, you cannot choose which one to use for care since that has been decided by one insurance being primary and the other secondary. Questions about your current policy and coverage are best directed to your workplace representative (HR, supervisor, etc) or by calling the customer service number on the back of your insurance card. While we can bill medicaid secondary insurance, we do not bill commercial secondary insurances.

New Year Updates

The new year often brings with it changes to our insurance plans. Any changes to insurance plans risks billing errors which risks. We encourage our clients to make an annual call to their insurances to verify any updates, changes in policies, or renewed payments/deductibles. 

Coordination of Benefits

A "coordination of benefits" is necessary when multiple insurance companies exist for a client. Each insurance company offers the member benefits. In order for us to bill using insurance, those insurance companies need to coordinate their benefits so that we know which insurance company to bill. This can only be done by the member of these insurance companies! You should start with who you understand to be your primary insurance company. As with any conversation you have with an insurance company, it is important to get the name of the representitive you speak with and a "call reference number" so that we can use it when following up on your behalf. 

Simple Practice

Simple Practice is the platform we use to support providing care to our clients. Through this secure and HIPAA compliant platform we can schedule appointments, conduct telehealth sessions, share documents, verify payments, and more with our clients. We have found it to be very user friendly! 

 

Frequently Asked Questions (FAQs):

Why don't all health care providers accept insurance?

Making money is essential to the existence of health insurance companies. There are many ways they accomplish this to include reducing benefits, declining coverage, contracting with providers at much reduced rates, and charging members high premiums. Basically, the more services they cover, the more they might have to pay and so the more than can off-set this, the more profitable they can be. 

When a health care provider agrees to work with insurance companies, they become more accessible to members like you who pay for their medical insurance coverage. However, they are also agreeing to accept the rates for their services set by that insurance company which will be less than the provider's actual rate... because profit. The provider may get more clients and be more accessbile, but they will get paid less for their services.

This is why providers often opt to not accept insurances... because they also need to make money and it is often more time consuming and costly to work with insurance companies. Insurance companies often do not make getting care easy for their members (though this is what they often promise) and they also do not make it easy for providers to use them. So why does our country rely on them so much? Good question. 

Here at TLC we choose to accept insurance companies because we believe in stepping up and stepping into systems, no matter how broken or difficult, to try and make a difference. This is why we have hired a billing team who is commited to our mission and vision and therefore are willing to work and wrestle with insurance companies on your behalf! 

Can I choose which of my health insurances to use for services here at TLC?

No. If you have more than one health insurance plan, you MUST tell us about both, as both may influence which of our clinicians you are able to see. When you have more than one health insurance plan, the one that is "primary" is predetermined by the health insurance companies. For example, if you have a commercial and a medicaid plan, the commercial plan will always be "primary" and your medicaid plan will be "secondary." If your combination of health insurance plans is different than this example, a "coordination of benefits," as described earlier on this page, will be required. Having multiple insurance coverages is common so it is important to know if this applies to you. If you are under 26 years old you may still be covered by your parents' plan. If you are married you each may be covered by the others' plan. If you're under 26 years old, have divorced parents each with individual plans, and you are married... well, you get the idea. Please let us know if it is possible you may be covered by more than one plan (you may not even know it). 

Why is the wait time different for different types of insurances?

Each of our clinicians are credentialed and "in-network" with different insurance companies. If you want to use your insurance for billing, we will do our best to pair you with one of the clinicians who is "in-network" with your insurance. Depending on the changing availability of the clinicians who are "in-network" with any given insurance, some wait times for certain insurance companies will be longer or shorter than others. Twin Lakes Counseling works hard to hire a variety of clinicians who can be credentialed and "in-network" with as many insurance companies as we can work with. 

How does insurance work for couples or family therapy?

We only bill one individual's insurance at a time for couples or family therapy, so often you can decide which insurance plan to use! However, it is important that you verify with the insurance you choose to use that the therapy you are seeking - "couples / family" - is covered. Some insurance companies only cover "individual therapy." Call and ask before deciding whose insurance to use!

We also ask that all members of the family or couple still provide their insurance information, even though we're only using one of the insurances at a time. This is because sometimes your clinician will need to have individual sessions with each of you, and it supports your treatment to have all insurances inputted and verified in advance.

Can I choose to not use my insurance at Twin Lakes Counseling?

Yes (although it may be complicated if you have Medicaid)! If you don't have Medicaid, you always have the option to pay for services out of pocket. We understand there are a variety of reasons to not involve your insurance company. If you choose this option, it is important to know that if you begin therapy as a self-pay client, and you decide you want to start using your insurance later on, this may impact your ability to keep your current clinician since not all of our clinicians are "in-network" with all our accepted insurances (see "Why is the wait time different for different insurance companies?"). Also, if you have Medicaid, did you know that there is a law that prohibits us from charging you for covered services (WAC 182-502-0160)? In order to circumvent this, you may need to sign a document (link) which declares your waiving of this option or we may refer you to a provider who is outside of these regulations. 

What happens when there are changes to my insurance situation? 

Please let us know! Our billing department is here to help minimize as many billing errors as possible. To do this, we need as much information as possible. If you let us know when changes are made - or if you are considering a change - please reach out through email or phone (253) 289-6099 so we can set you up for a smooth transition! 

Can I talk to someone about my specific situation/circumstance?

Absolutely! Twin Lakes Counseling's billing department is eager to help you understand your insurance situation and we deeply appreciate communicating with our clients and potential clients. We believe in early and often communication to avoid and prevent problematic billing! 

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