Cost Share Terms and Conditions
(Copay / Coinsurance)
Last Updated: November 4, 2022
- Medical Plan Access:
- In some instances, Lyra and your employer may make access to Lyra Providers available to participating employees and their dependents (collectively, “Members”) through the Medical Plan (“Plan”).
- In such instances, the Member may be responsible to pay out of pocket for a share of costs (e.g., session fees) covered by the Plan (“Cost Share”). “Cost Share” generally includes any Copayment, Coinsurance, Deductible, or similar charges as described in the Plan.
- Lyra’s services are not covered by Medicare, and Lyra does not accept Medicaid. If you have insurance coverage through Medicare or Medicaid, you are financially responsible for any costs that are not covered by your employer or another Medical Plan in which you are enrolled.
- Cost Share Charges:
- In the instance that you are a Member and are responsible for any Cost Share related to your Lyra sessions, Lyra will charge you these fees directly.
- Amount of Cost Share: The exact amount of these fees is based upon your specific Plan, including whether or not any deductible applies. If you have reached your out-of-pocket maximum for the year, Lyra will not charge you any additional Cost Share.
- Timing of Charges: A “Claim” is a request for payment that your Lyra provider will submit to Lyra following any session, visit, or provision of covered services. You will be charged once your session is completed, your provider submits a Claim, and that Claim is adjudicated by your Plan. In most instances, Lyra will not charge you more than 120 days after a session has occurred, and will usually charge much sooner. If you have concerns about timing, we encourage you to discuss with your provider the timing of when he/she will submit a Claim.
- Payment Method: When you register your Plan with Lyra, you will be asked to provide credit card information. Lyra will store this credit card on file and charge it for all Cost Shares for you and your minor dependents who are linked to your account. If at any time you wish to edit, delete, or update the credit card on file, you may do so online.
- Expired Payment Method or Failure to Pay: If at any point in time your credit card on file with Lyra expires and you do not update the information, or you otherwise fail to pay your required Cost Share, Lyra may refuse to cover sessions unless or until you satisfy any outstanding balance. If Lyra denies your provider’s Claim on this basis, your provider may charge you directly for any session fees incurred.
- Overcharges: If the amount charged to you varies from the amount you were expecting under your Plan, or you dispute that you were provided services, you have the right and responsibility to contact Lyra immediately.
- Authorization: Lyra will charge your Cost Share to your credit card on file, as described above. You agree to make the payment using your chosen payment method. IF YOUR ACCOUNT IS SUBJECT TO A COST SHARE, YOU AUTHORIZE LYRA TO CHARGE YOUR CHOSEN PAYMENT METHOD THE DESIGNATED COST SHARE, TYPICALLY AT THE TIME OF EACH CLAIM SUBMISSION OR ADJUDICATION BY YOUR PLAN. YOU MUST CANCEL YOUR REGISTRATION AND DIRECT YOUR PROVIDER NOT TO SUBMIT CLAIMS TO LYRA IN ORDER TO AVOID OWING YOUR APPROPRIATE COST SHARE.
- Submitting claims to your medical plan:
- When you see a Lyra Provider through your Plan, Lyra may be required to submit a Claim to your Plan for reimbursement. This may occur either directly by Lyra, or by a subcontractor on Lyra’s behalf.
- If Lyra submits a Claim related to your sessions, Lyra will provide all relevant information for the Claim to be processed by your Plan. This may include (but is not limited to) patient name, diagnosis, and services received.
- If you do not want Lyra to submit a Claim to your Plan, you should not see Lyra Providers through your Plan.
- General Terms:
- Term and Termination: This agreement will remain in full force and effect while you use the Website, any Services and/or are a registered user (a “Member”).
- Changes: If we need to change the terms of this Agreement, we will post the revised Cost Share Terms and Conditions through our Website and update the “Last Revised” date to reflect the date of the changes. You are responsible for being aware of any changes made to this agreement. By continuing to use our Services after we post such changes, you agree to modified terms.
- Non-Electronic Copy: By accessing the Web Site or registering for Lyra’s Services, you consent to have this agreement provided to you in electronic form. You have the right to receive this agreement in non-electronic form. You may request a non-electronic copy of this agreement either before or after you electronically agree to the agreement. To receive a non-electronic copy of this agreement, please send an email to [email protected].
- Withdrawal of Consent to Electronic Agreement and Effect of Withdrawal: You have the right to withdraw your consent to have this agreement provided to you in electronic form. Should you choose to withdraw your consent to have this agreement provided to you in electronic form, we will discontinue your access to your account. This means you will not have the right to use Lyra’s Services unless, and until, we issue you a new username and password. We will only issue you a new username and password after we receive a signed copy of a non-electronic version of this agreement. To withdraw your consent, please send an email to [email protected]. Your withdrawal of consent will be effective within a reasonable time after we receive your withdrawal notice. Your withdrawal of consent will not affect the legal validity or enforceability of this electronic agreement prior to the effective date of your withdrawal.