Paying Your Family's Patient Responsibility

Overview

Understanding Your Patient Responsibility

When your child receives ABA services through insurance, there are usually two parts to every claim: the portion the insurance pays and the portion that may be owed by the family. That family portion is called patient responsibility. It can include things like copays, coinsurance, or deductibles, depending on your specific insurance plan. Every insurance company (and every plan at every insurance) works a little differently, which is why this amount isn’t the same for every family.

If you have a Medicaid plan or have Medicaid secondary, you will not have any patient responsibility. If you have Commercial insurance or TriCare or ChampVA, you may or may not have patient responsibility, depending on your benefits.

Why We Collect Patient Responsibility

Insurance companies require providers to collect the patient’s share of the cost. Not doing so can put your coverage at risk and can also violate the contracts we have with insurance companies. Collecting patient responsibility ensures that:

• Your benefits stay active and compliant

• Claims are processed correctly

• We can continue providing high-quality care without interruptions

We also understand that billing can feel confusing, so our goal is to make this process as transparent and stress-free as possible.

When We Charge Patient Responsibility

We never charge at the time of service. We also never charge based on an estimate. Instead, we wait until your insurance company processes the claim and sends us an official statement called an Explanation of Benefits, or EOB.

An EOB tells us:

• What services were billed

• What the insurance paid

• The exact amount you are responsible for (if any)

Only after the EOB is received do we bill you for your portion. This ensures the amount is accurate and based on the insurer’s final determination, not a guess or estimate.

How Much Patient Responsibility Might Cost

The exact amount depends entirely on your insurance plan. Some plans have a fixed copay per day, others apply a percentage (coinsurance), and some require you to meet a deductible before insurance begins paying. To help prevent surprises, our team verifies your benefits before therapy starts.

Once we complete the verification, we send you a breakdown that explains:

• What your plan covers

• Whether you have a copay, coinsurance, or deductible

• Any expected out-of-pocket costs

This helps you understand what to expect before services begin. The report will have an important section that looks like this:

Some important terms to keep in mind to understand your benefits:

• Copay -- A fixed dollar amount you pay when you receive a healthcare service. If your insurance policy has a copay for ABA therapy services, each day you receive services from Alpaca Health, you pay a set amount.

• Co-insurance -- Your share of cost after insurance pays its portion. If your insurance policy has a co-insurance for ABA therapy services, each day you receive services from Alpaca Health, your insurance pays a percentage, and you pay the remaining percentage. The amount you owe may depend on the type of service and level of clinician that provided the service.

• Deductible -- The amount you must pay out of pocket before insurance starts covering its portion. When you get a service, it is first billed to insurance. If you haven’t met your deductible, your insurance will apply the service cost towards it, and you will get billed for that amount. After you’ve met your deductible, you’ll be responsible for your co-pay or co-insurance until you reach our individual or family out-of-pocket maximum.

• Out Of Pocket Maximum -- The most you will have to pay for covered services in a plan year. This amount is the maximum you’ll pay for any healthcare services received during a plan year, including services from Alpaca Health and other providers. Once the individual or family limit is met, insurance will cover 100% of services for the remainder of the plan period.

How do we collect patient responsibility?

During onboarding, you will input your credit card information into Alpaca. On a weekly basis, we charge your card for patient responsibility. We only charge patient responsibility when insurance finalizes the claim.

Billing card on file

Our system notifies you every Friday about the outstanding patient responsibility that insurance is requiring us to charge. You can go anytime into the Alpaca patient portal and look into the patient responsibility if there are questions.

On Sunday, we will charge you the amount that we notified you on Friday.

Keep in mind, we are only billing you the amount that insurance has required us to bill.

The notification email will look something like this:

View outstanding patient responsibility balance and Invoices

On the Billing & Payments tab, you can see a running balance of your paid and outstanding patient responsibility. You can also download invoices with detailed session information.

Paying specific claims

You can also pay specific claims by checking the checkbox at the beginning of each row, and then click the Pay button that appears at the bottom of the page. Finally follow the prompts to complete the payment through Stripe.

Change the card on file

If you want to change the card on file, on the left-hand side of your parent portal, click "Open Billing Portal" where you can edit the card on file.

What if I'm having financial difficulties?

If you’re facing a tough financial moment, let us know. We handle these situations one case at a time and will do our best to work with you. Just email support@alpacahealth.io, and we can handle your situation on a case-by-case basis.

What if I have a question or disagree with a bill?

If you ever have a question about a statement or something does not look right, please email us at support@alpacahealth.io. We are happy to walk you through the charges, the dates of service, and how insurance applied your benefits.

If you disagree with the amount that insurance says you owe, please know that we only bill you based on finalized Explanation of Benefits (EOBs) from your insurance company. That means we are required to use the amounts they determine. In those cases, you will need to call the member services number on your insurance card and ask them to review or explain the EOB. If they make a change, they will send us an updated EOB and we will adjust your account accordingly.

For reference, our billing information is:

Harvi Technologies, Inc dba Alpaca Health
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