Understanding your insurance benefits
Updated: Apr 6, 2020
Am I covered?
This is generally very simple to determine. Please call your insurance company to find out if you are covered for out patient psychotherapy in an office setting by an LMSW. Ask what your coverage is. The agent will tell you what your benefit level is. They will explain if services are covered by a deductible, coinsurance or a fixed copay.
When you call your insurance company please make sure to ask for the representative's name and a reference number when you call. This can make it easier for the next agent to follow along with your last conversation if you have to call again about a similar topic.
What is a deductible?
A deductible is an amount you, the insured, must pay before the insurance company begins covering any portion of your treatment. You are not expected to pay the entire deductible at one time. When you are covered by a deductible you pay the insurance allowed amount per visit. The deductible resets every year on January 1st. You can expect to start paying your deductible again at the first of the year.
What is coinsurance?
Coinsurance is the percentage of the cost you pay. When you call your insurance company you may be told that after the deductible you are covered 80/20. That means, after your deductible is met that you are responsible for 20% of the cost and the insurance company will cover 80% of the cost.
What is a copay?
A copay is a fixed dollar amount that you pay for each session.
What does Out of Pocket Maximum mean?
This is the maximum amount you will pay for healthcare in a year. Copay amounts are not always included in this out of pocket maximum. Your insurance representative will be able to tell you if this is applicable to office visit copay amounts or only deductible and coinsurance amounts.