How Does KEGE Conduct Eligibility Checks?

To verify your insurance benefits, our team conducts eligibility checks using the policy information that you provide for us. 

Prior to every visit, we use the insurance information you provided during the intake process to search for your insurance plan details by accessing your insurance payer portal or calling your insurance payer directly. 

Once our team locates your insurance plan, we search for your mental health benefits in your insurance portal to determine your estimated responsibility for each visit. From there, we communicate that estimated cost to you via email.

KEGE conducts eligibility checks at the following points: 

• Before your first visit with your provider (please note that we require 1 business day to complete these eligibility checks)
• On a monthly cadence if your plan remains the same
• Any time your insurance details are updated in the Patient Portal

Will the estimated cost in my eligibility email change?

As mentioned in the eligibility email, the cost that we quote you for every visit is an estimate and is subject to change. 

Your insurance company ultimately decides what you owe for each visit and as a result, they may process your claim with a different cost than what was initially quoted.  

While we attempt to provide the most accurate estimate up front, there can be many complexities within each plan that can lead to a difference in cost when the claim processes. Since this is determined by your health plan and not us, we are only able to relay information that we have access to at the time of the eligibility check. 

Note that, if there are no errors, insurance claims processing can take 45-60 days. Health plans can also reprocess claims weeks or months after the initial processing if they identify an error in their internal processes after the fact. 

Am I able to check my own estimated cost? 

Yes, all clients can contact their insurance carrier to determine the cost of each visit by calling the number located on the back of their insurance card. You may also use an estimating tool by clicking here.

What occurs if my claim processes with a different cost?

If your health plan processes your claims with a different cost than our initial estimates, our team will adjust your past invoices accordingly. We will also update your eligibility check to reflect the cost your insurance says you owe for future visits. 

You can locate the final amount you owe on your Explanations of Benefits once your health plan has finished processing your claim. 

If you owe less than the original estimate, we will issue you a refund and adjust all future invoices to match the final cost determined by your health plan.

If you owe more than the estimate, you will be issued an invoice for the difference between the initial quoted cost and the final cost listed on your EOB. 

Billing Partner

KEGE Center for ADHD works with a billing partner called Alma to manage medical insurance billing. Alma specializes in handling insurance billing matters, including copayments and coinsurance, on our behalf. They are a trusted partner, and handle insurance plans copayment, and or coinsurance.