Understanding Your Insurance & Payment
Navigating insurance can be confusing. To help you plan for the cost of care, here is a quick guide to the terms you’ll see on your "Explanation of Benefits" (EOB) and how they apply to our sessions.
The Basics: What You Pay
Deductible: This is the amount you pay for healthcare services out-of-pocket before your insurance begins to pay. If you have a $1,000 deductible, you are responsible for the full cost of sessions until that $1,000 is reached.
Copayment (Copay): A fixed fee (e.g., $25) you pay at each appointment. This is usually due at the time of service.
Coinsurance: Instead of a flat fee, some plans charge a percentage (e.g., 20%) of the total session cost. This usually kicks in after your deductible is met.
The Safety Net: Out-of-Pocket Maximum
This is the most you will have to pay for covered services in a plan year. Once you spend this amount on deductibles, copays, and coinsurance, your health insurance pays 100% of the costs.
Working with an "Out-of-Network" Provider
If I am not an in-network provider for your specific insurance plan, you may still be able to receive care using Out-of-Network (OON) benefits.
How it works:
Pay Upfront: You pay the full session fee at the time of our appointment.
The Superbill: At the end of the month, I provide you with a document called a Superbill. This is an itemized receipt that includes the necessary clinical codes.
Submit for Reimbursement: You send this Superbill to your insurance company.
Get Paid Back: Depending on your plan, the insurance company may mail you a check for a portion of the session fee (often 50% to 80% of the "allowed amount").
Pro Tip: Call the number on the back of your insurance card and ask: "Do I have out-of-network benefits for outpatient mental health (CPT code 90837)?"