In 2023, Pennsylvania began checking eligibility for Medical Assistance (MA) again after a three-year break due to COVID19. A lot can change in three years, and you may find you are no longer eligible for MA. Or, maybe you are still eligible but did not submit your renewal application by the deadline. What does that mean for you and therapy at our office?

Below are a few scenarios and information that we hope will be helpful. Please note that our therapists do not get paid for appointments unless either insurance or the client pays for them.

If your MA coverage lapsed but you are still eligible

If your Medical Assistance coverage lapses, there will be a period of time where you do not have insurance benefits. During this time, you will be “uninsured.” You will be responsible for the cost of any appointments at our office.

If you know your insurance is lapsing, it is very important you let us know right away. That way we can come up with a plan or put therapy on hold until your MA is active again.

The Department of Human Services sometimes advises people their MA coverage can be “back-dated,” meaning MA will go back and pay for services  you received when it lapsed. In our experience, this does not apply to behavioral health services! Behavioral health services are covered by a managed care company called PerformCare. Any “back-dating” usually does not apply to services covered by PerformCare.

You might also be told your therapist can simply “bill the state.” We cannot do this. Our therapists are credentialed with PerformCare; they are not eligible to bill the state.

If you have questions about your behavioral health coverage, we recommend you contact Member Services at PerformCare. Our office cannot contact the Department of Human Services to talk about your situation with them.

If your child’s insurance is changing from MA to CHIP

If your child will be transitioning from MA to a CHIP plan, there are a couple of things to know.

First, we often seen a one-month gap between when MA ends and when CHIP begins. If your child is seen for therapy during this time, you will be responsible for the cost. Let us know right away if your child’s insurance is changing, so we can work together on a plan and ensure you don’t have any surprise costs!

Second, not all therapists at our office are eligible to bill CHIP. If your child’s therapist is not yet licensed, they are not eligible to bill CHIP. Unfortunately, your options in that situation will be either 1) continue with your current therapist and self-pay for therapy, or 2) transfer to a licensed therapist so that CHIP will pay for therapy.

Finally, our office does not accept all CHIP plans. CHIP is provided by several different insurance companies. We work with Highmark, Capital, UPMC, and Geisinger. We do not accept Aetna or United HealthCare (UHC).

One more thing to know…

For clients with Medical Assistance (MA), behavioral health coverage and physical/medical coverage are provided by different insurance companies. When MA coverage ends or lapses, the two insurance plans often have different end-dates. Our office uses your end-date with PerformCare, which is the behavioral health insurer. You can contact Member Services at PerformCare  for more information about your coverage.

Questions? Contact our Billing Coordinator/Office Manager at (717) 422-6440, ext. 20.