Figuring out if you have primary/secondary insurances/MassHealth/Medicare, and who covers your behavioral health services:

Call your insurance plan(s) (use the number on the back of your insurance card) and ask:

1. (If you’re not sure if you have more than one insurance, or which is primary or secondary)

   • Do I have more than one health insurance plan on file?

   • Which one is my primary and which one is my secondary?

2. (If seeking to use secondary insurance for services):

   • If a mental health provider is not in-network with my primary, but is in-network with my secondary, can I still be covered?

   • Will I need to pay out-of-pocket for services upfront and submit claims to my secondary insurance for reimbursement?

3. Are either my primary or secondary insurances a MassHealth (Medicaid) or Medicare product?

4. Does my insurance company manage behavioral health services directly, or is it managed by another company?

   • What is the name of that behavioral health provider or subcontractor and how could I contact them?

Once you’ve identified which company covers your behavioral health services, call them and ask them:

1. Are psychiatric medication management and/or psychotherapy, provided both in-person and via telehealth covered when provided by this practice:

   Alicia S. Yeung, DNP, PMHNP, PLLC

   NPI 2: 1083500706

2. Do I need any prior authorizations or referrals?

3. What will my out-of-pocket costs be in terms of my:

   • Copay

   • Deductible

   • Co-insurance

If Alicia is not in-network, ask the company that covers your behavioral health services:

1. Do I have out-of-network benefits for outpatient psychiatric and psychotherapy services — both in-person and via telehealth?

2. What is my annual out-of-network deductible and how much remains?

3. After I meet my deductible, what percentage of each session will be reimbursed?

4. Specifically, how much will I be reimbursed for the following CPT codes?

   • Initial Evaluation: 90792 or 99204/99205, possibly with 90833 or 90836

   • Psychotherapy Only: 90834 or 90837

   • Medication Management Only: 99213, 99214, or 99215 (depending on complexity)

   • Combined Medication Management + Psychotherapy: 99213, 99214, or 99215 plus 90833, 90836, or 90838 (depending on session length)

We encourage you to document these conversations, including the name of the representative you speak with, the date, and any confirmation numbers or notes.

Even when a provider is in-network, your health insurance plan may still require you to pay out-of-pocket costs such as a deductible, copayment, or coinsurance. These are determined by your specific insurance policy, not by Alicia.

• A deductible is the amount you must pay out-of-pocket each year before your insurance starts covering services. This means that if you haven't met your deductible yet for the year, you're responsible for paying the full contracted rate for sessions until the deductible is met—even if Alicia is in-network.

  • Most deductibles reset annually, typically on January 1st or July 1st. Be sure to mark your calendar with this date to avoid unexpected costs.

• A copay is a fixed amount you pay for each visit, as specified by your plan.

• Coinsurance is a percentage of the cost of services that you’re responsible for, even after meeting your deductible.

For the most accurate information about your mental health benefits and current deductible status, it's best to contact your insurance provider directly.

To find out if your plan uses a third-party behavioral health administrator, you can:

• Check the back of your insurance card – Look for a separate phone number or a note about behavioral/mental health services.

• Call your insurance company – Ask who manages your behavioral health benefits (your main insurer or another company).

• Log into your insurance portal or review your plan documents – Look for mentions of a separate company managing therapy or psychiatry.

Here are examples of common behavioral health administrators (as of August 2025):

OPTUM

• UnitedHealthcare (most plans): Optum is the behavioral health administrator for the majority of UnitedHealthcare plans.

• Mass General Brigham Health Plan (MGBHP): Optum manages the behavioral health benefits for most MGBHP commercial plans.

• Student Health Plans: Optum manages many university-sponsored plans, such as those under UnitedHealthcare Student Resources and certain Aetna Student Health plans.

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS (BCBSMA)

• In-house management: in most cases, BCBSMA manages its own behavioral health benefits and network.

AETNA

• In-house management: in most cases, Aetna manages its own behavioral health benefits and network

• Meritian Health: Aetna provides its behavioral health provider network to Meritian Health plan

CARELON BEHAVIORAL HEALTH (formerly Beacon Health Options)

• MassHealth: Carelon manages the behavioral health benefits for most MassHealth-related products, often through the Massachusetts Behavioral Health Partnership (MBHP).

• Wellpoint Massachusetts: Carelon administers behavioral health and substance use services for all Wellpoint Massachusettsmembers.

• Anthem: This includes some out-of-state Blue Cross Blue Shield plans that utilize Anthem and, in turn, contract with Carelon for behavioral health services.

• Some Employer-Sponsored Plans: Carelon also serves a number of employer-sponsored plans.

POINT32HEALTH

• Harvard Pilgrim Health Care (commercial plans): Managed directly by Point32Health.

• Tufts Health Plan (commercial and ConnectorCare plans): Managed directly by Point32Health.

EVERNORTH

• Cigna commercial plans: Evernorth is the behavioral health administrator for Cigna's commercial plans.

You might have both primary and secondary insurance if:

• You’re a minor covered by both parents’ insurance plans

• You have your own plan and are also covered under your spouse’s plan

• You have Medicare and another plan (such as employer or retiree coverage, from either yourself or your spouse)

• You have both Medicare and MassHealth (Medicaid)

• You’re a U.S. veteran with both VA benefits and another insurance plan

• You’re using COBRA coverage along with a new plan after changing jobs

To check if you have both types of coverage, look at your insurance cards—they may say “Primary” or “Secondary.”

You should also call the customer service number on the back of each of your insurance card(s) and check (see first FAQ on verifying if Alicia is in-network).

MassHealth is the Medicaid program for Massachusetts. You might have MassHealth if:

• You receive health coverage through a state program or applied through MA Health Connector.

• You have a MassHealth insurance card, often blue and white, that says “MassHealth” on it.

• Your income qualifies you for low- or no-cost health insurance.

• Your plan’s name shows up in the most recent MassHealth Enrollment Guide.

MASSHEALTH PLANS (as of 2025)

WellSense Health Plan

• WellSense Care Alliance (ACO)

• WellSense Beth Israel Lahey Health (BILH) Performance Network ACO (ACO)

• WellSense Community Alliance (ACO)

• WellSense Mercy Alliance (ACO)

• WellSense Boston Children’s ACO (ACO)

• WellSense Essential (MCO)

Tufts Health Together

• Tufts Health Together (MCO)

• Tufts Health Together with UMass Memorial Health (ACO)

• Tufts Health Together with Cambridge Health Alliance (CHA) (ACO)

Mass General Brigham Health Plan

• Mass General Brigham Health Plan with Mass General Brigham ACO

Fallon Health

• Fallon 365 Care (ACO)

• Berkshire Fallon Health Collaborative (ACO)

Community Care Cooperative (C3)

• Community Care Cooperative (C3) (ACO)

Be Healthy Partnership

• Be Healthy Partnership Plan (ACO with Signature Healthcare and Southcoast Health)

Other MassHealth Programs and Plans

• PCC Plan (Primary Care Clinician Plan)

• Senior Care Options (SCO)

• Program of All-inclusive Care for the Elderly (PACE)

• One Care

• MassHealth Fee-for-Service

If you're still not sure, call the number on the back of your insurance card to ask or contact MassHealth Customer Service at (800) 841-2900.

Medicare is a federal health insurance program primarily for people age 65 or older, or those with certain disabilities or health conditions (such as end-stage renal disease). If you have Medicare, your plan may be either:

• Original Medicare, provided directly by the federal government, or

• A Medicare Advantage Plan (Part C), provided by a private insurance company (such as Aetna, Blue Cross Blue Shield, UnitedHealthcare, or Mass General Brigham Health Plan).

You might have Medicare if:

• You have a red, white, and blue Medicare card with your name and a Medicare number

• You’re over age 65 or receiving Social Security Disability Insurance (SSDI)

• You see deductions labeled “Medicare Premium” on your Social Security check or bank statement

• You have a private insurance card that mentions “Medicare Advantage,” “Medicare HMO,” “Medicare PPO,”“Part C”, or “Senior”

MASSACHUSETTS MEDICARE PLANS (as of 2025)

Aetna Medicare

• Aetna Medicare Advantage (HMO)

• Aetna Medicare Prime (HMO-POS)

• Aetna Medicare Premier (PPO)

• Aetna Dual Eligible Special Needs Plans (D-SNPs)

Blue Cross Blue Shield of Massachusetts

• HMO Blue

• Medicare PPO Blue PlusRx

• Medicare Advantage PPO

Commonwealth Care Alliance (CCA)

• CCA Senior Care Option (HMO SNP)

• CCA One Care (HMO SNP)

eternalHealth

• eternalHealth Forever HMO

• eternalHealth Freedom PPO

• eternalHealth Give Back PPO

• eternalHealth Horizon HMO

Fallon Health

• Fallon Medicare Plus (HMO)

• Fallon Navicare (HMO SNP)

Mass General Brigham Health Plan

• Mass General Brigham Medicare Advantage (HMO-POS)

• Mass General Brigham Medicare Advantage (PPO)

Tufts Health Plan

• Tufts Medicare Preferred (HMO)

• Tufts Medicare Preferred (PPO)

UnitedHealthcare

• AARP Medicare Advantage from UHC (HMO-POS)

• UnitedHealthcare Senior Care Options (HMO D-SNP)

Wellcare

• Wellcare No Premium (HMO)

Medicare Supplement (Medigap) Plans

In Massachusetts, Medigap plans are standardized into three types. The names of the plans themselves are consistent, but the insurance company offering them will be different.

• Core Plan

• Supplement 1A Plan

• Supplement 1 Plan

If you’re still confused, you can verify if you have Medicare by:

• Calling Medicare at 1-800-MEDICARE (1-800-633-4227)

• Check your status online Medicare.gov

• Contacting your insurance plan

Self-Pay: If you do not have a MassHealth or Medicare product as either your primary or secondary insurance, you may choose to pay out-of-pocket for services with Alicia.

Out-of-Network (OON) Benefits: You may also contact your insurance provider to ask whether your plan includes out-of-network benefits that could help cover part of the cost of services with Alicia (see first FAQ about verifying OON Benefits).