Understanding Your Insurance Coverage
Understanding your insurance coverage, especially as it relates to specific services like therapy, is often cryptic, confusing and intimidating. Please look over the information below to help you understand and decipher your specific policy. Prior to your first appointment, our intake staff or your therapist will also check your benefits and work with you to understand what financial liability (if any) you will have as part of utilizing our services.
We strongly recommend that all clients call their insurance company to understand their benefits.
Prior to calling your insurance company, please familiarize yourself with the following terms and be sure to ask your representative about each of these:
Deductible
Deductible is the amount of money that you may need to pay out of your own pocket before the policy benefits "kick in." Remember that not all policies have deductibles and to make it more confusing, not all services you might seek are subject to the deductible.
Ask the representative:
"Do I have a deductible and does it apply to outpatient psychotherapy either in an office or via Telehealth?"
Copayment
A copayment or "copay" is the amount you may need to pay per visit with your therapist. If your deductible does not apply to outpatient therapy, you may need to pay this amount each time you visit until you meet your out-of-pocket-maximum.
If you are required to meet your deductible, you will need to pay the contracted rate to the therapist which will then be applied to (subtracted from) your deductible amount. Contracted rates vary based upon what kind of insurance you have. If you have a deductible, your therapist or our intake team will discuss this amount with you.
Out-of-Pocket-Maximum
Out-of-pocket-max is the maximum amount of money you may need to spend given your specific policy in a given year or policy period. Put another way, once you pay this amount, the insurance company pays every cent of any remaining covered services you receive during the specified policy period.
Co-Insurance
Some policies work by paying a percentage of covered services while you pay the remaining percentage. For example, if your policy states that you have 50% co-insurance, then you are required to pay half of the contracted rate for the covered service while your insurance company pays the other half. Again, your co-insurance rate may only become relevant after your deductible is met and also may vary according two the covered service provided.