Therapists with the Private Pay Booster can run eligibility checks to see if a future client has out-of-network benefits.
Running an eligibility check can help you determine:
- If a client has out-of-network coverage for the services you provide
- How much their deductible is for out-of-network services
- The remaining amount of their out-of-network deductible (year to date)
- The percentage that the insurance company is likely to reimburse after the deductible has been met
With the Private Pay Booster, there are two ways for therapists to check a potential client’s out-of-network benefits: In the Zencare Members portal and in the Reimbursify portal.
Zencare Members portal
Therapy-seekers can choose to send you their insurance information through the messaging tool.
When a potential client sends you their insurance information, Zencare will retrieve their out-of-network benefits and deductible information. We’ll show you the details of their coverage alongside the client’s initial message.
We encourage you to send the client the template we provide to explain their out-of-network reimbursement and deductible.
Listed fees are estimates; encourage the client to reach out to their insurance company to confirm coverage.
Reimbursify portal
You can still check a therapy-seeker’s out-of-network benefits, even if they don’t send you a message through Zencare! Here’s how:
1. Log in to the Zencare Members portal.
2. Go to the menu on the left of your dashboard. Click on the “Log into Private Pay Booster” button.
If you do not see this button in your Members portal, please contact the Zencare support team!
3. Navigate to Verify Benefits, where you can check the Eligibility & Benefits for existing or prospective clients to estimate their out-of-pocket cost.
4. Submit insurance information. You will see results like this:
5. Communicate the results to the therapy-seeker. Here’s an example of how you can describe coverage:
“It looks like your insurance will cover up to 50% of the session fee! Initially, our sessions will be $150 (my full rate). You have $750 of your deductible remaining, which you’ll hit after 5 sessions with me. Then you can get reimbursed, so your out-of-pocket cost will likely range between $75 and $120 per session.
This is a quick estimate, so please double-check with your insurance company to confirm.”
Note: Verification of Benefits does not guarantee reimbursement of services. The reimbursement rate applies to the allowed amount for the session, not the full session fee.