Insurance and self-pay

What are the payment options for each program?

How does benefits verification work?

1. Tell intake whether you are requesting psychiatry or IOP.
2. Share your plan information through the approved private intake process.
3. Ask about network status, deductible, copay or coinsurance, and any referral or authorization requirement.
4. Confirm the expected cost and appointment details before care begins.

Benefits verification does not guarantee coverage or payment. Your plan determines the final benefits and patient responsibility.

Which insurance plans are listed?

Intensive outpatient program

IOP insurers: Aetna, BlueCross BlueShield, Cigna / Evernorth, UnitedHealthcare / Optum.

Outpatient mental health and psychiatry

Listed outpatient plans: Aetna, Cigna / Evernorth, Humana, UnitedHealthcare / Optum, BlueCross BlueShield, Medicare, Wellpoint (non-TennCare plans; verify with intake).

• Aetna
• Cigna
• Humana
• Optum
• UnitedHealthcare
• Medicare
• BlueCross BlueShield
• Wellpoint

TennCare is not accepted.

Confirm your exact plan, provider and requested service with intake. Network participation and benefits must be checked separately for psychiatry and IOP.

Does insurance cover telehealth psychiatry?

Coverage for psychiatric video visits depends on your own plan’s telehealth and mental health benefits, not on the insurer’s name alone. MedlinePlus cautions in its telehealth overview that some insurance companies may not cover telehealth visits, so check before the first appointment.

When you call your insurer, ask about the service and the format together:

• Is a psychiatric evaluation by video a covered benefit on my plan?
• Is a medication management follow-up by video covered the same way?
• Does my plan send mental health claims to a separate behavioral health company?
• Is my cost share for a telehealth visit different from an office visit?

The psychiatry insurance and cost guide walks through a full psychiatry benefits check.

Does insurance cover a virtual IOP?

A virtual IOP can be covered as a mental health benefit, but it is checked separately from psychiatry and against a shorter list: the 4 IOP insurers named above.

Intensive outpatient care is a recognized mental health service: Medicare.gov, for example, lists intensive outpatient program services among the outpatient mental health care Medicare covers. Whether your own plan pays for a video IOP, and how much, is a question about your specific benefits, which is why intake checks before the first group.

For a program that runs 8–12 weeks, ask how many program days are approved at a time, whether video groups are billed the same way as in-person ones, and what your share is per day. The IOP insurance and cost guide covers parity and appeals in depth.

In-network vs. out-of-network: what changes for me?

In network means the provider has a contract with your plan, so you pay the plan’s agreed cost share; out of network means there is no contract, and you usually pay more, or the plan pays nothing. HealthCare.gov defines a network as the facilities, providers and suppliers your plan has contracted with.

Network status is checked per service. A plan can include Great Care for psychiatric visits without including the IOP, which is why intake checks each program on its own. If your plan treats Great Care as out of network, compare the self-pay prices on this page with whatever out-of-network coinsurance your plan would charge.

What do deductible, copay and coinsurance mean for my visit?

These three terms decide what you pay after your plan applies its rules. HealthCare.gov defines them this way:

Ask which of the three applies to a psychiatric visit and which to an IOP day. Co-payments are due at the time of service, as the patient policies state.

Does my plan need to approve care first?

Sometimes. HealthCare.gov describes prior authorization as approval a plan may require before a service is covered, and a referral as a written order to see a specialist.

Whether yours applies depends on the plan and the service. Ask intake to check both before your start date; the IOP insurance and cost guide covers approvals for an 8–12-week program.

Does a virtual IOP need prior authorization?

It may. HealthCare.gov describes preauthorization as your plan’s decision that a service or treatment plan is medically necessary, and a plan can ask for it before a program even when single office visits need nothing of the kind.

1. Give intake your plan details; the evaluation sets out the proposed program.
2. Ask whether approval is needed before the first group day.
3. Ask how many days or weeks one approval covers, and when it is reviewed again.
4. Keep a reference number for every call you make.
5. If a request is denied, ask the plan for the reason in writing; HealthCare.gov explains how to appeal an insurance company decision.

Approval is a coverage decision, not a clinical one: the evaluation decides whether the IOP fits you.

What will I owe at each visit or program day?

Without insurance you owe the published self-pay price each time; with insurance, what you owe depends on where you are in your plan year, because the deductible usually comes first and a copay or coinsurance applies after it.

Ask your insurer which line of your benefits each one falls under, and how close you are to your out-of-pocket maximum for the year.

How do self-pay prices add up?

Self-pay is charged per visit for psychiatry and per program day for the IOP, so the total depends on how often you attend. The examples below are arithmetic only, not a quote or a treatment plan.

Your provider decides how often follow-ups happen, and intake can tell you how many program days are planned each week.

What does a self-pay price include?

Each self-pay price covers the Great Care visit or program day it names; ask intake what else, if anything, could be billed separately. Medicine bought at a pharmacy is normally a separate cost from the visit, and the psychiatry cost guide answers related questions.

Can I use insurance for one program and self-pay for the other?

Ask intake; it depends on your plan and on what the benefits check shows for each program. Decide before care starts, so each bill matches what you agreed.

What should I ask my insurer before starting?

Ask your insurer five short questions and write down the answers with the date and the name of the person you spoke to:

1. Is the practice in network for my plan?
2. Is telehealth mental health care covered the same way as office care?
3. How much of my deductible is left this year?
4. What is my copay or coinsurance for this service?
5. Is approval or a referral needed first?

Who answers which billing question?

Some questions belong to Great Care and some to your insurer, and asking the right one first saves time.

What if my insurer is not on the list?

If your insurer is not listed, call intake before assuming anything either way. Self-pay at the published prices remains an option.

For a plan you are unsure about, the simplest step is to read the member ID card to intake and let them check.

Is TennCare accepted, and what are my options if I have it?

TennCare is not accepted. That applies to every Great Care service, psychiatric visits and the IOP alike, so a TennCare card cannot be used for care here.

• If TennCare is your only coverage, call the member services line for your TennCare health plan and ask for in-network mental health providers.
• If you also have another plan, give intake both cards so the other coverage can be checked.
• If you decide to pay yourself instead, ask for a good faith estimate first.

If you feel unsafe while a coverage question is still open, call or text 988, or call 911; neither line asks about insurance first.

Why does the out-of-pocket maximum matter for a multi-week program?

Because program days add up quickly, your plan’s yearly out-of-pocket maximum can be reached partway through an IOP, and after that point covered in-network care is paid by the plan for the rest of the plan year. Ask your insurer how much of the maximum you have already used before you choose a start date.

Timing matters too. A program that begins late in a plan year can straddle a reset, so the deductible may start again for the final weeks. Payments you make as self-pay, outside your plan, may not count toward either amount.

Which paperwork should I keep during care?

Keep one folder, paper or digital, for every money document tied to your care, so a billing question can be settled from your own records:

• Notes from each insurer call, with the date, the name and the reference number
• Any approval or denial letter from your plan
• A good faith estimate, if you pay yourself
• Each statement from the office and each notice your insurer sends after a claim
• Receipts for co-payments made at the time of service

Can I get a good faith estimate if I pay myself?

Yes. If you are uninsured or not using insurance, the federal No Surprises Act gives you the right to a good faith estimate of expected charges before care. CMS describes the law as one that protects people from unexpected medical bills.

For self-pay care here, ask for an estimate that names the services you are booked for: the evaluation at $250, follow-ups at $150, or IOP days at $200 each. Keep it with your statements and compare every bill against it.

The CMS good faith estimate page lists what an estimate must contain, and the psychiatry insurance and cost guide covers when it is due.

Does Medicare cover telehealth mental health care?

Yes, Medicare covers outpatient mental health care by telehealth. Medicare.gov lists psychiatric evaluation and medication management among its outpatient mental health services and names telehealth as one way to receive them.

Medicare also publishes its own telehealth rules. What they mean for the cost of a psychiatry visit, including the Part B deductible, is covered on psychiatry cost and insurance.

• Medicare is on Great Care’s outpatient psychiatry list.
• Medicare is not on the IOP insurer list, so ask intake before planning the IOP with Medicare.
• Medicare Advantage plans can have different telehealth benefits, so give intake the plan card you actually use.

Do psychiatry and IOP benefits work the same way?

Not necessarily. A plan can treat a single psychiatric appointment and a multi-week program very differently, so each is checked on its own.

• Psychiatry: billed by visit
• IOP: priced per program day for self-pay
• Approval rules may apply to one and not the other

Tell intake about both if you might use both.

What should I do if a bill looks wrong?

Call the office first with the statement in hand, and compare it with any explanation of benefits your insurer sent. A wrong plan number or service date is the kind of error the office can look into. If you think a federal billing protection applies, the CMS No Surprise Billing page explains how to raise it.

What happens if my insurance changes during care?

Tell intake as soon as you know about a new plan, a new member ID or a coverage end date. Benefits are then checked again for the care you are still receiving, so there are fewer surprises on the next bill.