Insurance & Reimbursement
We work for you — not your insurance company.
Brain Body Health Alliance is a direct-pay specialty practice. That means we don't contract with insurance networks, and we aren't paid by — or accountable to — any insurance company. We're accountable to you.
This is a deliberate choice. When a practice answers to insurers, the length of your visit, the tests that get ordered, and the treatments that get approved are shaped by what a plan will reimburse. We've stepped outside that system so the only thing shaping your care is your clinical need and your goals. You get unhurried visits, direct access to your physician, and a treatment plan built around you.
Transparent fees, no surprises.
We believe you should know exactly what your care costs before you receive it. Our fees are published and consistent — no facility fees, no surprise charges, no balance-billing games. You can review the cost of every visit and service before you book. If you ever have a question about a charge, just ask; we're always happy to walk you through it.
A primer on out-of-network benefits
Being out-of-network does not mean your insurance is useless. Many plans — especially PPOs — include out-of-network benefits that can reimburse you for part of what you pay us. The key is understanding how those benefits work, because out-of-network coverage behaves differently from the in-network care most people are used to.
Here's the general flow for an out-of-network visit:
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Because we're not in your network, payment happens between you and us, not between us and your insurer.
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A superbill is an itemized medical receipt with the diagnosis and procedure codes your insurance needs. You submit it to your insurance company to request reimbursement.
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Most plans have a separate out-of-network deductible — an amount you pay yourself before the plan starts reimbursing. This is often higher than your in-network deductible, and it resets each year.
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Once you've met the out-of-network deductible, your plan typically reimburses a percentage of its allowed amount for each service. Two things matter here, and they're where people get surprised:
The percentage and the deductible vary widely from plan to plan. We can't tell you yours — only your plan can.
The reimbursement is based on the plan's allowed amount, which may be different from what you paid. The difference between a provider's fee and the plan's allowed amount is sometimes called balance billing, and out-of-network providers are generally permitted to charge it. (We keep our fees transparent precisely so there are no surprises here.)
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With out-of-network care, the reimbursement usually comes back to you, not the practice — which is part of what keeps the relationship between you and us, not us and the insurer.
HSA and FSA: paying with pre-tax dollars
Whether or not you ever get reimbursed by insurance, you can often pay for your care here with pre-tax money through a Health Savings Account (HSA) or Flexible Spending Account (FSA). Because our services are qualified medical expenses, this is one of the most reliable ways to lower the real cost of out-of-network care.
HSA (Health Savings Account). If you're enrolled in a high-deductible health plan, you may have an HSA. The money is yours, it rolls over year to year, and it never expires. You can use your HSA debit card to pay us directly, or pay out of pocket and reimburse yourself from the account later. HSA funds spent on qualified medical care are tax-free.
FSA (Flexible Spending Account). An FSA is an employer-sponsored account funded with pre-tax dollars that you use for medical expenses during the plan year. Unlike an HSA, FSA funds are generally use-it-or-lose-it, so it's worth planning your care around your plan year. Most FSAs issue a debit card you can use with us, or you can submit your receipt for reimbursement.
For either account, keep your superbill and payment receipts — that's the documentation your administrator may ask for.
An example: the SC PEBA State Health Plan
To make this concrete, here's how the publicly available South Carolina PEBA State Health Plan (administered by BlueCross BlueShield of SC) is structured for out-of-network care. We use it only as an example of how to read a plan — your own benefits, even on the same plan, depend on your specific coverage, your deductible status, and the plan year, so always verify yours directly.
The PEBA State Health Plan is a PPO, which means it does include out-of-network benefits — you're not locked out for seeing us.
Reading PEBA's own published summary, an out-of-network visit follows the pattern above: you meet a separate out-of-network deductible, then the plan pays coinsurance on its allowed amount, and an out-of-network provider may bill more than that allowed amount.
PEBA also notes that with an out-of-network provider, you may need to file the claim yourself — which is exactly what your superbill is for.
What this means in practice for a PEBA member: your care with us is very likely eligible for out-of-network reimbursement, but the amount you get back depends on where you are with your out-of-network deductible and your plan's coinsurance terms.
To find your specifics, log in to My Health Toolkit or MyBenefits, or call BlueCross at the number on your card, and ask the out-of-network questions listed above.