Great Lakes Wellness
Counseling in Jenison MI

To verify your insurance coverage, simply call the member services number on the back of your card to confirm the therapist you want to work with is in-network and ask about your copay or deductible.

Alternatively, provide your insurance details to our intake team, and we will verify your benefits for you before your first appointment.

Accepted Commercial Insurance (In-Network)

• Aetna: Includes all commercial PPO and HMO therapy coverage.
• ASR Health Benefits: Proudly serving as an in-network provider.
• BCBS & Blue Care Network (BCN): Comprehensive coverage for most Michigan Blue Cross Blue Shield plans.
• Cofinity: Full network participation for all Cofinity plans.
• ComPsych: In-network provider for ComPsych EAP and behavioral health services.
• Priority Health: Accepted for all commercial insurance plans.
• Tricare: Dedicated mental health support for military families.
• UnitedHealthcare (UHC): Participating provider for most UHC commercial policies.

Michigan Medicaid Managed Care (MCO)

• Blue Cross Complete (BCBS Medicaid)
• McLaren Health Plan (Medicaid)
• Molina Healthcare (Medicaid)
• Priority Health Choice / Total Health Care

Medicare Therapy Coverage

If your insurance plan isn’t listed, don’t worry!

You can still utilize your insurance by tapping into your out-of-network benefits or through a special option known as a single case agreement.

Using Out-of-Network Benefits: 

• Check with your insurance provider for out-of-network benefits and inquire about potential reimbursement rates. While many plans offer these, reimbursement is not guaranteed.

• You will pay our full session fee upfront. Upon request, we can provide you with a Super Bill (detailed receipt) to submit to your insurance company for potential reimbursement.

Using a Single Case Agreement:

• A Single Case Agreement is a unique, not-used-very-often-one-time contract that temporarily allows our office to be considered in-network with your specific insurance plan, even if we do not typically participate with it.

Fee for service or cash out of pocket is accepted.

Cash rates vary by provider. If you want to pay with cash, please speak with the provider you wish to meet with. They will complete a payment agreement form with you demonstrating the agreement you have with them about paying cash.

Paying for counseling without using insurance provides greater privacy, choice, and flexibility:

• Maximum Privacy: Your mental health records, diagnoses, and treatment details are not shared with insurance companies.

• Your Choice of Provider: You are free to choose a therapist based on their qualifications and your personal preferences, rather than being restricted to a limited network.

• Potentially Lower Cost: For individuals with generally low healthcare needs or high deductibles, paying a session fee privately may be cheaper than meeting a large out-of-pocket deductible.

• Treatment Flexibility: You can receive services (like venting, general guidance, or specific couples/family issues) that insurance companies often do not cover because they are not considered “medically necessary” or do not have a corresponding billing code.

A Deductible is the amount you must pay out-of-pocket for covered health care services at  Great Lakes Wellness Counseling before your insurance plan begins to pay its share. This amount varies significantly by insurance provider and plan.

Example:

• Scenario: John has a $3,000 deductible and has already paid $2,700 for other medical visits.

• The Gap: He has $300 left to meet his deductible.

• Counseling Cost: His first three therapy sessions are each billed at $100 out-of-pocket, totaling $300.

• Result: He meets his $3,000 deductible with the payment for the third session. His fourth appointment and all subsequent covered services will be paid at 100% by his insurance.

A Copayment (or “copay”) is a fixed amount you pay for a covered health care service after you have met your deductible. Copay amounts can vary depending on the type of service you receive.

Example:

• Scenario: John Doe has met his $3,000 deductible.

• The New Cost: His insurance plan now requires a $20 copay per visit once he met his out of pocket deductible.

• Result: John will owe just $20 for each subsequent appointment until the deductible resets (usually at the start of a new calendar year).

Important Note: Deductibles and copays typically reset at the beginning of the year, which is why your out-of-pocket costs may increase again early in the new year.

Co-insurance is the percentage of the covered healthcare cost you are responsible for paying after you have met your deductible.

It differs from a copay because a copay is a fixed dollar amount, whereas co-insurance is a percentage.

Example:

• Cost: The allowed cost for a therapy session is $100.

• Rate: Your co-insurance rate is 30%.

• Result (Deductible Met): You pay 30% of the $100 cost, which equals $30. Your insurance pays the remaining 70%.

• Note: If you have not met your deductible, you would still be responsible for the full $100 allowed amount.

Using Multiple Insurance Plans (Secondary Coverage)

If you plan to use more than one insurance plan (primary and secondary), please inform us immediately to prevent processing delays and billing complications.

How it Works:

1. Primary Submission: We first submit the claim to your Primary insurance (e.g., Blue Cross Blue Shield).

2. Secondary Submission: Once the Primary insurance processes the claim and determines your initial balance, we then submit the remaining balance to your Secondary insurance (e.g., Priority Health).

3. Final Balance: After both plans have processed the claim, we will have a clear, final determination of your total balance due.