Fees & Insurance
IMPORTANT NOTICE of fee policy change effective 07/01/2016
Keeping excellent mental health care affordable for everyone
If you or someone in your family needs mental health care or substance abuse treatment, please don’t worry about whether you can afford care at Peak Wellness Center. We will work with you to make sure you can afford it.
Using your health insurance at Peak
We’re happy to bill any insurance/3rd party payer on your behalf. Peak Wellness Center will bill your insurance on your behalf. Please present your insurance card at the time of check in, and provide all information needed to process the claim, including dates of coverage. You will be expected to pay your responsibility at the time of service. We contract with these and other agencies:
- CIGNA (Formerly Great West)
- Tricare (Active Duty; must have referral; only pays for eligible providers)
- BCBS (includes Federal BCBS and KidCare Chip)
- Medicare (Must see a Medicare authorized LCSW, MD, DO, or Nurse Practitioner for Medicare to pay)
- RR Medicare (Must see an RR Medicare authorized LCSW, MD, DO, or Nurse Practitioner for Medicare to pay)
- Wyoming Medicaid
Learning whether your insurance company covers services at Peak
If you don’t see your insurance company on the list above, check your insurance plan details or contact your insurance company to learn the answers to these questions:
- Is Peak Wellness Center considered an “in-network” provider on your insurance plan?
- Are there any authorizations required or steps you need to follow to makes sure your insurance covers your care with us?
- Are there any specific limitations on the type of provider you must see in order for insurance to cover the cost of your appointments at Peak?
- What are your insurance benefits on your plan? For example, are there limitations in the number of counseling appointments insurance will cover and does your insurance cover prescription medications?
Working with the restrictions or limitations of some insurance plans
Some insurance companies reimburse for only selected, eligible providers. For example, sometimes insurance will cover appointments with a psychiatrist, doctor, nurse practitioner or licensed clinical social worker, but the plan might not cover the cost of a parenting class or case management services.
We will make every effort to assign you to an eligible provider, however, we cannot guarantee the provider you see will be eligible for reimbursement by your insurance company. You will be responsible for all uncovered charges incurred for the provider by whom you are seen, should you choose to see the ineligible provider.
Peak services or care providers not covered by your insurance
If your insurance doesn’t cover a specific Peak care provider or service in your treatment plan, we will then look at adjusting fees for our services based on your income, to make sure they remain affordable for you.
The fees for our services
Peak Wellness Center makes discount mental health and substance abuse services available to those in need through a Sliding Fee Discount Application process for individuals who are uninsured or underinsured. Insured individuals qualify in limited circumstances. The Sliding Fee Discount is based upon the Federal Poverty Guidelines, which are published annually, establishing income and family size parameters for the Discount from full fee.
All patients seeking services at Peak Wellness Center are assured that they will be served regardless of ability to pay. No one is refused service because of lack of financial means to pay.
Request for discount: Requests for discounted services may be made by patients, family members, social services staff or others who are aware of existing financial hardship. Information and forms can be obtained from the Front Desk and the Business Office.
Administration: The Sliding Fee Discount Program procedure will be administered through the Chief Financial Officer or his/her designee. Information about the Sliding Fee Discount Program policy and procedure will be provided and assistance offered for completion of the application. Dignity and confidentiality will be respected for all who seek and/or are provided chartable services.
Alternate payment sources: All alternative payment resources must be exhausted, including all third-party payment from insurance(s), Federal and State programs.
Completion of Application: The patient/responsible party must complete the Sliding Fee Discount Program application in its entirety. By signing the Sliding Fee Discount Program application, persons authorize Peak Wellness Center access in confirming income as disclosed on the application form. Providing false information on a Sliding Fee Discount Program application will result in all Sliding Fee Discount Program discounts being revoked and the full balance of the account(s) restored and payable immediately.
If an applicant is unable to be processed due to the need for additional information, the applicant has two weeks from the date of notification (date applicant notified PWC of need to apply for Program) to supply the necessary information without having the date on the application adjusted. If a patient does not provide the requested information within the two-week time period, their application will be re-dated to the date on which they supply the requested information, and charges incurred in the interim period will be at the regular fee. Any accounts turned over for collection as a result of the patient’s delay in providing information will not be considered for the Sliding Fee Discount Program.
Eligibility: Discounts will be based on income and family size only. Peak Wellness Center uses the Census Bureau definitions of each:
Family is defined as: a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family.
Income includes: earnings, unemployment compensation, worker’s compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources. Noncash benefits (such as food stamps and housing subsidies) do not count.
Income verification: Applicants must provide one of the following: prior year tax return, W-2, three most recent pay stubs, letter from employer, or Form 4506-T (if W-2 not filed). Self-employed individuals will be required to submit detail of the most recent three months of income and expenses for the business. Adequate information must be made available to determine eligibility for the program. Self-declaration of income may only be used in special circumstances. Specific examples include participants who are homeless. Patients who are unable to provide written verification must provide a signed statement of income, and why (s)he is unable to provide independent verification. This statement will be presented to Peak Wellness Center’s Chief Financial Officer or his/her designee for review and final determination as to the sliding fee percentage. Self-declared patients will be responsible for 100% of their charges until management determines the appropriate category.
Discounts: Those with incomes at or below 100% of poverty will receive a full 100% discount. Those with incomes above 100% of poverty, but at or below 200% of poverty will be charged according to the attached sliding fee scale. The sliding fee scale will be updated during the first quarter of every calendar year with the latest federal poverty guidelines, http://aspe.hhs.gov/poverty.
Nominal Fee: Patients receiving a full discount will be assessed a $7 nominal fee per visit. However, patients will not be denied services due to an inability to pay. The nominal fee is not a threshold for receiving care and thus, is not a minimum fee or co-payment.
Changes in your household income: Please let us know about any changes to your income or financial status, including the number of people dependent on your household income, so we can make sure we have you in the right fee bracket.
Financial Documents
Notice of Sliding Fee Policy Change 07/01/2016
Fee Schedule
Sliding Fee Scale
NEW Slilding Fee Discount Application
Additional Financial Resources
Coverage to Care (C2C) offers a wealth of tools and resources to help you navigate the health care system, so you can make the most of visits to your local health center.
Still have questions about fees and insurance for Peak services?
Contact us anytime or we can answer any questions you have during your first appointment.