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Insurance Concepts

If you're using your insurance there are some concepts that will be good to know. If something is unclear here don't worry our office manager will be happy to give you more details about it. 

  • Allowed amount: The amount your insurance will recognize as acceptable for Mental Health Office Visits. We charge $250 per session (for a standard individual therapy session), however, each insurance determines how much of our fee they are willing to pay. That is the “allowed amount”. For most in-network insurances, it is a flat fee, that has been previously negotiated. 

  • Deductible: Many plans have a deductible amount, which refers to the out of pocket amount that the patient will need to pay before the insurance will be responsible to make any payment of their own. This amount varies greatly between insurances. After you have met your deductible amount, you will sometimes have a Co-pay or Co-insurance amount due that will be your new patient responsibility. 

 

  • Co-pay - Co-Insurance : Once you meet your deductible you may have a flat fee that you must pay pay per visit called a Co-pay. Or you could have a Co-insurance, a percentage of the total fee or “allowed amount” that you must pay per visit.

  • Effective Date: Date that your insurance become active. 

  • Plan Date: Date that your insurance cycle resets. This could mean that your deductible will reset and your benefits might change. It's good to contact your insurance when your plan resets to know if there are any changes in your benefits.  

  • Primary Insurance: Insurance that will be responsible for making the payments for the visits. Be sure to not be listed under another insurance (previous job, partner, family, etc.) and if you have another insurance listed please provide us the information to determine which insurance will be responsible to make the payments. 

  • Out of pocket Maximum: If you have many medical expenses over the year you may reach your out-of-pocket maximum, if your policy has one. Once you reach your out of pocket maximum this would mean that your insurance company covers 100% of the costs for your visits from that point on, until the new policy year begins.

  • Claim processing: All insurance plans come with a disclaimer that benefits are not guaranteed until the claims are processed. We do our best to give you a clear understanding of your costs but if the insurance company determines you owe a different amount than we charged you, you are responsible for the difference or we will issue a refund if you were overcharged.

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