If a patient is on the insurance plan for one of our clients, their coverage details can be found in the Client Insurance Info Spreadsheet.
- These patients will be tagged with the employer name in Healthie.
Some patients are employees of a client but are not on the company insurance plan.
- These patients will still be tagged with the employer name in Healthie.
- The billing team will also add the “Individual insurance” tag.
Some patients are not affiliated with a client but have insurance that Utopia WellCare accepts.
- The billing team will add the “Individual insurance” tag.
For all patients with the “Individual insurance” tag:
- The billing team will document the number of covered visits and the renewal date in the Insurance Eligibility section of the patient’s Healthie profile.

After a patient uses their guaranteed covered visits for the plan year, they can still schedule additional visits.
- These visits may have out-of-pocket costs (copay, coinsurance, or deductible).
For any patient scheduling visits beyond their guaranteed covered visits:
- Add the “self pay with insurance” tag.
- This indicates the patient has agreed to potential out-of-pocket costs.
Because coverage varies by plan, patients should contact their insurance carrier to confirm their exact out-of-pocket cost.
The following reflects the 3 most common scenarios and is not a guarantee of coverage:
1. Patients pay a specialist copay or coinsurance amount (typically listed on their insurance card), usually ranging from $10 to $80. This is most common for patients in the overweight or obese BMI range.
2. Patients pay a deductible, usually ranging from $90 to $140. This is most common for patients in the healthy BMI range.
3. Patient’s visits are covered at 100% because they’ve already met their out-of-pocket maximum for the year.
HSA or FSA cards can be used to pay for out-of-pocket appointment costs.