Insurance & Billing
Get to Know the Process
We get it. Insurance is confusing. Understanding your benefits is essential to navigating care, but that information can be hard to find and understand.
We hope that this page will give you a jumpstart on managing your care and if you need to know more, just ask!
Understanding Your Possible Costs
Every insurance plan applies copays, deductibles and coinsurance differently.
Copay
A fixed amount that may be assigned to each visit, such as $25. Copays tend to vary by provider type (primary care, specialists, etc.) and mental health is not usually printed directly on the card.
Copays are not always applied predictably and may not be charged based on plan details, met deductibles, and more.
Coinsurance
A percentage of the insurance-approved cost that you may owe, often after your deductible has been met.
Whereas copays are a fixed amount, coinsurance is a fixed percentage. Insurance also determines the "allowed amount" (how much they will pay a provider for a service), so the client cost can only be estimated before claims have fully processed.
Deductible
An amount you may be required to pay toward covered services before your insurance begins paying.
Some patients must pay the full insurance-approved amount until their deductible is met, while others have the deductible applied gradually or not applied to therapy claims at all.
The key (and most frustrating) word when discussing insurance is "may". Claims typically take anywhere from 2 weeks to 2 months to process. Even experienced billing specialists cannot know the final patient responsibility until the insurer processes the claim.
Insurance FAQs
When it comes to insurance, there are no dumb questions! We've compiled a list of the most common, but invite clients to contact admin@roswellmindcare.com with any questions regarding billing, insurance, payments, and affordability.
1
Does RMC take my insurance?
We currently participate with:
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Medicare
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New Mexico Medicaid
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Aetna
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Blue Cross Blue Shield
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90 Degree Benefits and Caprock
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Humana
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Molina
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Magellan and Presbyterian
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TRICARE and TriWest
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Optum and UnitedHealthcare
Your insurance card may display an employer plan, administrator or smaller benefit-plan name that uses one of these larger networks. Please contact us before assuming that we do not accept your coverage simply because its name does not appear above.
Coverage details depend on your specific plan. RMC may be able to get a preliminary estimate, but contacting your insurance company directly is typically the most accurate.
2
What info will I need to contact my insurance?
Clients are responsible for providing accurate, current insurance information and are encouraged to confirm their benefits directly with their insurance company.
Some info you may need:
Legal business name: Roswell Infusions LLC
Agency NPI: 1174231484
Practice address: 300 S. Lea Avenue, Roswell, NM 88203
Type of service: Outpatient mental-health therapy (code CF)
Standard services: An initial mental-health intake (CPT 90791) followed by weekly therapy sessions (CPT 90837)
Contact us if the representative requests additional information, cannot locate our practice, or says that we are not covered by one of the companies listed above.
3
What if the estimate I paid is wrong?
Fees are due at the time of service. When we receive information indicating that you will likely have a regular copay or other predictable cost, we may begin collecting that estimated amount at each appointment.
Clients may sometimes be permitted to wait until claims have processed in lieu of pre-paying an estimated amount. Choosing to wait can result in several visits being added to your account before the final patient responsibility is known and are subject to our 7 day auto draft policy.
Once insurance has cleared the first few claims, your billing can be adjusted to match the amounts established by the insurance company.
If you overpaid:
Any overpayment will be applied to future balances. If you are not expected to have any future balances, you will be refunded any overpayment.
If you underpaid:
RMC will provide notice of any balance due. These balances are subject to the payment and card-on-file terms detailed in your signed financial agreement.
Payment plans and alternate arrangements may be available on a case-by-case basis.
4
What is my responsibility?
Clients are requested to follow the prescreener/intake prompts to upload insurance cards so that RMC can review prior to your intake appointment and whenever your coverage changes.
You are responsible for telling us about:
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New or replacement insurance cards
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Changes in coverage
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Medicaid or Medicare coverage
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Secondary and tertiary insurances (anything more than one)
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Changes to the order of your primary and secondary plans
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Coverage obtained through a spouse, parent or employer
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Terminated or inactive coverage
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Changes of employment, marital status, address, or any other life changes you think may impact your coverage
Having an insurance card does not always mean that full medical and mental-health benefits are active. Some programs provide only limited benefits, such as family-planning only or other restricted coverage, and may not cover outpatient therapy.
Failure to provide accurate insurance information promptly may prevent us from submitting claims within the insurer’s filing deadline. If a claim cannot be paid because of incomplete or inaccurate coverage information, the resulting balance may become the patient’s responsibility. This includes failure to renew Medicaid coverage.
Questions or Concerns?
Email: admin@roswellmindcare.com
Life happens, and we understand. Payment plans or alternate arrangements may be available on a case-by-case basis. Contact us as soon as possible if needed.
Please do not hesitate to reach out with questions about coverage, insurance information, billing, or requests for payment arrangements. Individual providers do not handle billing.