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Understanding Client Charges: Insurance and Cash Pay

  • Updated

Depending on a provider's cash pay rate, there may be instances when a client's copay, coinsurance, or deductible when using insurance is more than the provider's cash-pay rate.

 

What is a master charge?

Tava allows providers to set custom cash-pay rates up to $350 per session for clients paying directly. When a client is using insurance to pay for their session, Tava is required to send the bill to the insurance payer at the standard master charge rate for the CPT code (e.g., $341 for CPT code 90791). However, the client never pays the full billed charge. The client only pays the amount the insurance allows per our contract.

 

What are contracted (allowed) rates?

Each insurance payer we work with on the Tava platform has a set contracted rate. For example, one payer might be $131. The difference between the the billed master charge ($341) and the contracted rate ($131) is written off. We do not pass this on to the client, nor take this from provider earnings.

 

Why would an insurance client pay more than the cash pay rate?

If the insurance applies the claim toward the client’s deductible, they may owe the entire allowed amount (in this example, $131). If the provider's custom cash pay rate is less than $131 (for example, maybe the provider set their rate to be $125) the insurance client would pay more than the cash pay rate. If the client has met their deductible, the client would usually only owe a copay or coinsurance.

 

What to say to clients:

“Your out-of-pocket cost is based on what your insurance allows and how your benefits apply. While my cash-pay rate is $125, insurance charges a separate contracted rate. If your deductible hasn’t been met, you may be responsible for the full amount dictated by your insurance.”

 

For extra help:

  • If the full master charge ($341 or similar) is being billed to the client, that’s an error. Please escalate to our support for review.

  • If a client questions whether the claim was processed correctly, they can call their insurance’s Member Services phone number listed on the back of their insurance card.

  • For details on setting a custom cash pay rate, or setting a sliding scale discount, see this article.

If you have any questions or concerns about incorrect billing or high client responsibility, please reach out to therapist-support@tavahealth.com.