Serene Minds is in network with the following insurances:
- Highmark BCBS DE
- Medicare Advantage (Aetna Medicare, Highmark Health Medicare, Cigna Medicare).
- Medicaid (Traditional, AmeriHealth Caritas, Health Options)
- Optum (Commercial plans only)
When scheduling your first appointment, our billing team will verify the eligibility and benefits with your insurance. It is also recommended that you should also verify your eligibility and benefits with your insurance independently before scheduling an appointment. If you are switching to a new insurance, please call a few days before your next appointment so our office can verify eligibility and benefits in advance and offer you options in case Serene Minds is out-of-network with your new insurance.
Before scheduling your appointment, it is a good idea to check with your insurance, if there is another insurance that is active as a primary insurance. Sometimes, there may be an old insurance that may be showing as primary with your current insurance despite being inactive. It is also important to do coordination of benefits with insurances in cases where there is a primary insurance and a secondary insurance so claims are not denied by your insurance. Coordination of benefits ensures that each insurance knows which one is primary and which one is secondary.
We can accept only DE Medicaid patients only. Out of state Medicaid patients should contact the providers in their respective states for scheduling appointments.
Patients switching from regular Medicare to Medicare Advantage Plans should call our office to check if Serene Minds is in network with their Medicare Advantage Plan. If you want to continue treatment with your current provider at Serene Minds, it is highly recommended to check the network status to ensure continuity of care and reduce your out of pocket costs. When selecting a Medicare Advantage plan, do not just look at variety of benefits the plan is offering, but also check if all your current providers accept the insurance. Please weigh your options carefully when selecting a Medicare Advantage plan.
If you have an insurance that we do not accept, we may still be able to help you. Our eligibility and benefits verification team may be able to verify your out-of-network benefits and give you an estimate of your financial responsibility. In some cases, we may be able to provide services and give you a receipt, that you may submit to your insurance for full or partial reimbursement according to policy of your insurance plan. Whenever possible, we recommend that patients seek care with in-network providers to lower their financial responsibility.
If you do not have insurance, we may still be able to see you for nominal out-of-pocket rates. Please call our office to discuss self-pay options.
Allowed Amount: Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance” or “negotiated rate.” If your provider charges more than the allowed amount, you may have to pay the difference.
Balance Billing: When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred (in-network) provider may not balance bill you for covered services.
Co-insurance: Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount. In-network co-insurance usually is less than out-of-network co-insurance.
Co-payment (Copay): A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. In-network co-payments usually are less than out-of-network co-payments.
Deductible: The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services. In-network deductibles usually are less than out-of-network deductibles.
Network: The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. If seeking care from a provider within the network, your deductible, co-pay and co-insurance is usually lower.
Out-of-Pocket Limit: The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit.
For full insurance terminology, visit HealthCare.gov