Assignment of Benefits

Effective Date: January 01, 2026

Purpose: This policy clarifies payment responsibilities, insurance billing procedures, and assignment of benefits for services provided at Midwest Psychiatric Associates LLC. It ensures transparency regarding in-network and out-of-network coverage while complying with standard billing practices.

General Payment Requirements: Payment for patient-responsible amounts (e.g., copayments, coinsurance, deductibles, or full fees when applicable) is due at the time of service unless otherwise arranged in advance.

Acceptable forms of payment include cash, credit/debit cards, and electronic transfers. 

We reserve the right to verify insurance coverage prior to or at the time of service.

In-Network Insurance Plans: If your insurance plan lists our practice/providers as in-network (participating), we participate in assignment of benefits.

You authorize us to bill your insurance company directly and accept direct payment from your insurer for covered services (assignment of benefits).

You remain responsible for any applicable copayment, coinsurance, deductible, or non-covered amounts, which are due at the time of service or upon receipt of an explanation of benefits (EOB) showing your responsibility.

We will handle submission of claims to your insurance and manage follow-up as needed.

Any balance after insurance processing will be billed to you promptly.

Out-of-Network Insurance Plans: If our practice/providers are out-of-network (non-participating) with your insurance plan, we do not accept assignment of benefits.

You are required to pay the full session fee at the time of service.

As a courtesy (and only if you provide complete insurance information), we may submit a claim to your insurance company on your behalf using a superbill or CMS-1500 form.

Any reimbursement or payment from your insurance will be sent directly to you (the patient/insured), not to our practice.

The amount of any reimbursement, if any, is determined solely by your insurance plan based on your out-of-network benefits, allowed amounts, deductibles, and other plan terms. We make no guarantee regarding coverage or reimbursement levels.

It is your responsibility to verify out-of-network benefits, obtain any required pre-authorization, and understand potential reimbursement prior to treatment.

Additional Provisions, Verification of Benefits: We may assist in verifying benefits as a courtesy, but ultimate responsibility for understanding your coverage lies with you. We recommend contacting your insurer directly.

Non-Covered Services / Self-Pay: For services not covered by insurance (e.g., certain evaluations, administrative services, or if no benefits exist), full payment is due at the time of service.

Late Payments / Collections: Balances not paid within [e.g., 30 days] of billing may incur late fees, and accounts may be referred to collections. You agree to be responsible for any collection costs incurred.

Changes to Policy: This policy may be updated; patients will be notified of material changes.

Acknowledgment: By scheduling and attending appointments, you acknowledge receipt and agreement to this policy. You may be asked to sign a separate financial responsibility and assignment of benefits form at intake or as needed for specific claims.

If you have questions about this policy, your insurance coverage, or billing, please contact our billing department at 417-262-6609, oe email at office@psychiatryhelps.com. Thank you for choosing Midwest Psychiatric Associates LLC for your mental health care. We are committed to providing high-quality services in a supportive environment.