Reimbursement Support

Navigating Insurance Reimbursement

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  1. Coverage Considerations
  2. Filing a Claim on Your Own
  3. Third-party Claims Services
  4. Avenues for Coverage

Wells Medicine provides out-of-network treatments. We are not contracted with any insurance company or payor, and we are not able to take insurance.

Payment is due at the time of service – by cash or charge

Some people simply pay and are done
Some people pay with HSA/FSA funds
Some people seek reimbursement: As a patient, you may be able to receive reimbursement directly from your insurer for the cost of treatments.  

Pursuing reimbursement for out-of-network treatment may be difficult and time-consuming. However, it comes with the potential benefit of eventually receiving some reimbursement – depending on the details of your plan and other considerations. 

We’ve provided information and resources below that may be helpful for navigating your options.

Coverage Considerations

Coverage by Treatment

Coverage varies greatly by treatment. You may be more likely to receive some reimbursement depending on your treatment and medical conditions. These are our observations according to typical patient experiences.

Out-of-Network Benefits

The first key consideration when pursuing reimbursement is your out-of-network benefits. 

Does your insurer cover out-of-network services? What are the details of your benefits? You may wish to speak with your insurance provider to review your out-of-network coverage and deductibles.

Variation in Policy

Coverage also varies greatly between insurers and insurance agencies. Researching your insurer at the beginning or speaking to people with the same policies can save you time and give you realistic expectations for your next steps.

A quick phone call with your representative or an online search for advice from people with similar experiences may help you determine how likely you are to receive reimbursement.

Filing a Claim on Your Own

First, confirm whether your insurer provides coverage for out-of-network treatment. 

Request a superbill from Wells Medicine for your treatment. This statement, often called a superbill, is an itemized receipt that includes the date of service, billing codes, and relevant information about the patient and our practice.

Go to the website of your insurer to submit a claim online or download a copy of the insurance claims form. It is advised that you review this information in full in advance as you may need to request additional information from doctors outside of Wells Medicine.

It may be helpful to speak with a representative of your insurer to inquire about the specifics of your coverage, get estimates for reimbursement and processing time, and to review paperwork with them before submitting your claim. Insurance companies may also have a mobile app or you may use a third-party app to guide you with submission and track your claim status.

Please note that this process often requires substantial back and forth with the insurance company. The insurer may deny your request several times before paying some portion of the requested funds, or before ultimately denying the request.

Third-party Claims Services

Third-party claims services specialize in claims management for out-of-network claims. These services may be helpful in navigating the insurance claims process and providing useful data on what you can expect regarding your specific policy and typical payment amounts. These services will charge a fee or commission for their service, sometimes contingent on claim reimbursement. 

Wells Medicine partners with a third-party insurance advocate that will file claims for office visits and consultations, ketamine infusion, and TMS. This company charges a 10% service fee, inclusive of deductible and coinsurance, contingent upon reimbursement. This may be a very good option if you have a low deductible.

How does the third-party reimbursement/claims support work?

Contact us if you are interested in enrolling with this third-party service for services with Wells Medicine. Patients may schedule a consultation with this service before enrollment to learn more about their insurance’s policies on out-of-network providers, treatment coverage, and other questions regarding insurance benefits.

After enrollment, Wells Medicine will provide the superbill for claim pursual, and you may be asked to provide additional information. The Insurance Advocates will verify and communicate with you about coverage information and update you as the process moves forward.

Avenues for Coverage

Gap Coverage

Some insurance plans offer gap coverage, or a network gap exception, for out-of-network treatments when there are no in-network providers available in your area or with the same degree of expertise. Ask your insurer if they provide gap coverage and whether your treatment or a similar treatment would ordinarily be covered by an in-network provider. They may be able to provide a network gap exception for treatments at Wells Medicine.

Self-Funded Plans

It is growing more common for employers to provide self-funded or partially self-funded plans. This means that an employer takes on the role of providing health care benefits to their employees in addition to contracting with an insurance agency. This enables employers to make decisions regarding coverage as they arise and the employer may cover more treatments or have more latitude to cover treatments than with more conventional insurance plans. If your employer provides a self-funded plan, speak with HR or the benefits department about receiving coverage for treatments at Wells Medicine.

Coverage for Treatment “Equivalents”

Some insurers may be more likely to provide coverage for treatments that have covered “equivalents”. For example, many insurers provide coverage for intranasal esketamine, a form of ketamine treatment that is more expensive than IV ketamine therapy and proven to be less effective – IV ketamine is shown to have slightly higher response and remission rates and require fewer treatments when compared to intranasal esketamine.

If your insurer provides coverage for similar services, they may also be willing to provide coverage for less-expensive and more-effective treatments provided by Wells Medicine.