Access to Coverage helps clients navigate the insurance process when requesting out-of-network mental health coverage.
We provide administrative advocacy and coordination, including help with paperwork, insurance communication, follow-up, and available appeal processes when appropriate.
Insurance companies and applicable review entities make all final decisions regarding coverage, authorization, reimbursement, and payment. Approval is never guaranteed.
Access to Coverage helps clients navigate the insurance process when requesting out-of-network mental health coverage.
We provide administrative advocacy and coordination, including help with paperwork, insurance communication, follow-up, and available appeal processes when appropriate.
Insurance companies and applicable review entities make all final decisions regarding coverage, authorization, reimbursement, and payment. Approval is never guaranteed.
The first part of the application collects your basic information, insurance information, therapist information, required authorizations, and consent to communicate.
There is a $150 non-refundable Administrative Intake Fee to begin the process.
This fee covers intake, opening your case, and our initial administrative review of your insurance plan and available options.
After Part 1, you can continue directly to Part 2 or return to it later.
Part 2 should take approximately 20 minutes.
Please complete it when you have enough uninterrupted time to answer carefully.
The information you provide helps us understand your circumstances and prepare the request.
Please provide as much accurate information as possible.
If you are unsure whether something is relevant, include it anyway.
Questions marked with an asterisk (*) are required.
Questions without an asterisk may be skipped if you genuinely do not know the answer.
Please answer all questions honestly and to the best of your ability.
Information submitted through our intake process may include personal and treatment-related information and is handled in accordance with our Privacy Policy.
After you complete your portion, please let your therapist know that they may receive an email from Access to Coverage.
Their portion should generally take approximately 5–10 minutes.
We may need information from your therapist before we can prepare or continue the request.
If required therapist information is not provided, we may be unable to proceed.
Once the necessary information is received, Access to Coverage reviews the case and prepares the appropriate administrative request.
Depending on the insurance plan, this may involve:
Once submitted, the insurance company reviews the request. Some cases are decided quickly, while others take several weeks. If additional information or appeals are required, the overall process may take longer. Access to Coverage cannot guarantee how long the insurance company or any outside review entity will take to issue a decision.
A denial does not always mean the process is over. Depending on the insurance plan and the reason for the denial, one or more internal appeals may be available. Some cases have one internal appeal, while others may have two. When an appeal is available, appropriate, and within the scope of our services, Access to Coverage may assist with:
If the insurance company’s internal appeal process is completed and the request remains denied, the insurer may issue a final denial or similar notice.
Depending on the insurance plan, applicable law, and circumstances of the case, additional options may be available, including an external or state-level administrative review.
Access to Coverage may review the available information and explain administrative options that appear to be available.
When an external administrative review is available, appropriate, and within the scope of our services, we may assist with the related paperwork and submission process.
Some external review, hearing, legal, regulatory, or clinical matters may fall outside the scope of our services.
The $1,000 Advocacy Completion Fee becomes due when a written approval for out-of-network coverage with the therapist involved in your case is issued during the period in which Access to Coverage is providing advocacy services for that request.
This may include a written:
The fee applies regardless of whether the approval is communicated directly to you, your therapist, Access to Coverage, or issued through an applicable administrative review process during the engagement.
The fee is also due even if, after approval:
An approval may be limited by:
The insurance company determines the terms of the approval.
Payment of the $1,000 fee is due in accordance with the payment terms stated in your signed Service Agreement and invoice.
The initial $150 Administrative Intake Fee remains non-refundable.
Insurance authorizations are usually limited by time, number of sessions, or other plan requirements.
If an authorization later expires or additional sessions are needed, the insurance company may require a renewal, reauthorization, or new request.
A future renewal or reauthorization is considered a separate administrative engagement.
Any applicable fee for that future work will be disclosed before the new engagement begins.
Please watch your email and respond promptly if we request additional information.
If information needed to continue the case is not provided, we may be unable to proceed.
If there is no response for an extended period, the case may be closed as inactive in accordance with the signed Service Agreement.
Your insurance company may send important documents directly to you.
Please send us clear copies of all:
Whenever possible, scan the entire document clearly and send every page.
Do not assume Access to Coverage automatically receives a copy.
Access to Coverage can only assist with documents and deadlines that are provided to us with enough time for us to reasonably review and act on them.
Please send time-sensitive documents to us as soon as you receive them.
The reimbursement process depends on the insurance plan and the terms of the authorization.
For many private insurance plans, a client may continue paying the therapist directly and receive a superbill.
The claim can then be submitted to the insurance company for processing.
The insurance company determines:
Approval does not mean the insurance company will reimburse 100% of the therapist’s fee.
Billing is a separate optional service from Access to Coverage’s advocacy services.
If you prefer assistance with eligible claim submissions, Access to Coverage may provide billing submission services when properly authorized.
Current Billing Fee: $50 per claim submission
One submission may include multiple dates of service when properly included on the applicable billing document.
Submitting a claim does not guarantee payment or reimbursement.
The insurance company makes all claim and payment decisions.
Medicaid and Managed Medicaid plans may operate differently from private insurance plans and may be subject to additional federal, state, and plan-specific requirements.
Depending on the plan:
Access to Coverage reviews these cases individually.
We do not guarantee any specific payment amount, reimbursement arrangement, or approval.
If applicable law, regulation, or plan rules prohibit charging the member for a particular administrative service, Access to Coverage will follow those requirements.
Please remember:
Set aside about 20 uninterrupted minutes for Part 2
Answer all required (*) questions
Provide as much accurate information as possible
If you are unsure whether something matters, include it
Tell your therapist to watch for our email
Keep every insurance document you receive
Send time-sensitive notices to us promptly
Respond promptly when we request information
This page provides a general explanation of Access to Coverage’s services and process.
Your signed Service Agreement governs your individual engagement. If there is any conflict between this page and your signed Service Agreement, the signed Service Agreement controls.
Access to Coverage provides administrative advocacy and coordination services only.
We are not an insurance company, healthcare provider, or law firm and do not provide medical or legal advice.
Insurance companies and applicable governmental or independent review entities make all final decisions regarding coverage, authorization, appeals, reimbursement, and payment.
Approval, coverage, reimbursement, and payment are not guaranteed.
Access to Coverage provides administrative advocacy and coordination services only. Insurance coverage determinations are made solely by the insurance carrier. Coverage, reimbursement, and payment are not guaranteed.
Access to Coverage is an independent administrative advocacy service and is not affiliated with any insurance carrier. We do not provide medical or legal advice.
732-475-2111
cs@accesstocoverage.com