Understanding the claims process: Submission, status, and common delays

Headway’s claims cycle

We’ve built systems that read insurance benefits in real-time, which allows us to surface the most up-to-date cost estimate at the time of service. This makes it possible for us to bill when the session happens, instead of waiting weeks for insurance to process your claims.

Here’s how it works:

1. Eligibility and price estimate
   Once you enter your insurance details, we'll find your mental health benefits and show you a cost estimate before you book.
   
   
2. Attend session and pay
   After your session, your provider will enter the billing code for your session to help insurance understand the type of service you received. Based on this, you’ll be charged your financial responsibility using the payment method we have on file for you. 
   
   
3. Claim submission
   Headway will submit your claim a few days after the session is confirmed.
   
   
4. Claim processing
   Your insurance will review your claim, which can take up to 45 business days*.
   
   
5. Explanation of Benefits sent
   After your insurer processes the claim, they’ll send you an Explanation of Benefits (EOB). If you receive an Explanation of Benefits (EOB), stating that you were charged incorrectly, reach out to us and we’ll work directly with your insurer. 
   
   
6. [Where applicable] Headway receives new information
   Your insurer may adjust the final cost based on plan details, like whether or not you’ve met your deductible. If you were overcharged, we’ll refund you the difference. If you were undercharged, we’ll automatically correct your pricing, and charge your payment method on file for the difference.

* See below for common reasons claims might be delayed. 

How to check claim status 

Headway will take care of processing your claims for you, so you don't need to keep tabs. If you’re curious about your claim status, haven’t received an EOB yet, and would like to check, you can call your insurer.

What to expect on the call:

1. You'll be asked to provide your member ID (found on your insurance card), date of birth, and date of session
2. Let the representative know you’d like to check on the status of a claim.
3. They’ll walk you through the information they need, and let you know what the status is.

If your insurer can’t find the claim, or you have trouble checking on the status, it’s possible that your claim has not been sent yet, or may be delayed. Reach out to us with a reference number from your call, and our team can help look into it. 

Claim delays 

We generally submit claims a few days after your provider confirms that your session happened in our system. While uncommon, in certain cases claim submissions may be delayed. 

If a claim is submitted on a delay:

• You won’t receive an explanation of benefits (EOB) until your claim is processed.
• If you call your insurance carrier, they will let you know that they do not have the claim(s) on file. 
• You’ll see a delay between the date of the session and it being reflected in your insurance portal.

We aren’t always able to determine how long delays will last. If you have any concerns about a delay with your claims, let us know. 

Common reasons for delays

Your provider is not officially added to your insurer’s provider system

Once providers are credentialed (i.e. paneled) with insurance plans, it can take insurance companies some time to update their system and add a provider. We hold claims during this gap to ensure your claims are processed seamlessly in-network.

If we do submit claims before this is updated, they will often come back denied and clients will receive an EOB explaining they owe the full cost of the session, which can cause unnecessary stress. 

A claim filing error occurred

While uncommon, it’s possible that we’re not submitting your claim because the information we have on file for you is incorrect.

Should this be the case, we’ll correct and/or validate the information and submit the claim.

Updates to our agreement with your insurer

We’re working with insurance companies on an ongoing basis to reach the best possible agreements for clients and providers. This means that sometimes our agreement with your insurer may change. 

During this time, we may pause claim submissions while the insurer’s systems are updated with the new terms. This is to avoid the need to reprocess claims, and to minimize any potential financial inconvenience for our clients.

If this happens, we will make any necessary adjustments to your previous charges as soon as the situation is resolved. 

Claim denials 

Your claim may be denied by your insurance company for a few different reasons: 

• Inactive insurance (terminated coverage)
• Out-of-network (OON) plan
• Non-covered mental health
• Coordination of benefits (COB)
• No telehealth benefits
• Maximum benefits reached
  
  

Inactive insurance / terminated coverage

If your insurance plan resets or changes, and you don’t update your plan details on Headway, it can result in an automatic charge for the full cost of care*.

To avoid any additional charges, be sure to always have an active insurance plan on Headway. If you don’t have an active insurance plan, you can switch to private pay for future sessions.

Out-of-network (OON) plan

While rare, sometimes our system is not initially able to detect when insurance plans are out-of-network (OON). As such, these OON plans are treated as in-network on our platform.

If your plan is ultimately determined to be ineligible for in-network care on Headway, you'll be responsible for the full cost of any sessions held under the insurance on file. In this case, we’ll send you an email and you’ll be automatically charged for the outstanding balance.

Non-covered mental health / non-covered telehealth

Certain insurance plans don’t cover mental health or telehealth sessions, and will deny coverage.

If your plan is ultimately determined to be ineligible for mental health or telehealth sessions, you'll be responsible for the full cost of any sessions held under the insurance on file. In this case, we’ll send you an email and you’ll be automatically charged for the outstanding balance.

Coordination of benefits (COB)

At this time we can only submit claims to primary insurance. If the insurance entered on your Headway account is your secondary insurance plan, you’ll be responsible for the full cost of any sessions held under that insurance plan on Headway. In this case, we’ll send you an email and you’ll be automatically charged for the outstanding balance.

To learn more about identifying primary vs. secondary insurance and taking care of your coordination of benefits, visit this helpful article: Secondary insurance and coordination of benefits.

Maximum benefits reached

Some insurance plans will only cover a set amount of sessions per year, called a benefit maximum. When that maximum is reached, insurers will begin denying the claims.

If your plan has a benefit maximum that you already reached, you'll be responsible for the full cost of any sessions held under the insurance on file. In this case, we’ll send you an email and you’ll be automatically charged for the outstanding balance.

In the event that you receive an explanation of benefits (EOB) stating that your claim has been denied, reach out to our support team. We’ll help determine why the claim was denied and next steps. 

* "Full cost of care" is defined as the cost that Headway has determined is the client's responsibility for the session, since the session is not covered by the client's insurance.