- \n
- Questions to Ask Your Insurance Provider<\/a><\/strong><\/li>\n
- Where to Find your Plan’s Information<\/a><\/strong><\/li>\n
- Cost Planning Examples<\/strong><\/a><\/li>\n
- Definitions of Key Insurance Terms<\/a><\/strong><\/li>\n<\/ul>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|desktop” admin_label=”Section” _builder_version=”4.27.5″ _module_preset=”default” background_color=”#efeae6″ custom_padding=”|50px|60px|50px|false|true” custom_padding_tablet=”|35px||35px|false|true” custom_padding_phone=”30px|35px|60px|35px|false|true” z_index_tablet=”0″ z_index_phone=”0″ z_index_last_edited=”on|desktop” da_disable_devices=”off|off|off” global_colors_info=”{}” da_is_popup=”off” da_exit_intent=”off” da_has_close=”on” da_alt_close=”off” da_dark_close=”off” da_not_modal=”on” da_is_singular=”off” da_with_loader=”off” da_has_shadow=”on”][et_pb_row column_structure=”1_3,2_3″ custom_padding_last_edited=”on|desktop” _builder_version=”4.27.5″ _module_preset=”default” width=”100%” custom_padding=”||||false|false” custom_padding_tablet=”0px||0px||true|false” custom_padding_phone=”0px||0px||true|false” z_index_tablet=”” z_index_phone=”” z_index_last_edited=”on|desktop” global_colors_info=”{}”][et_pb_column type=”1_3″ admin_label=”Column” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Every Plan is Different ” _builder_version=”4.27.5″ _module_preset=”default” title_font=”BebasNeue Bold|–et_global_body_font_weight|||||||” title_text_color=”#1F2B8E” title_font_size=”40px” title_line_height=”1.2em” custom_margin=”||4px|||” custom_margin_tablet=”” custom_margin_phone=”” custom_margin_last_edited=”on|desktop” title_font_size_tablet=”36px” title_font_size_phone=”30px” title_font_size_last_edited=”on|desktop” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.5″ _module_preset=”default” text_font=”Nunito Sans||||||||” text_text_color=”#000000″ text_font_size=”18px” text_line_height=”1.4em” header_3_font=”–et_global_body_font|300|||||||” header_3_text_color=”#404041″ header_3_font_size=”30px” header_3_line_height=”1.2em” header_4_font_size=”20px” width_tablet=”100%” width_phone=”100%” width_last_edited=”on|desktop” custom_margin=”||27px||false|false” custom_margin_tablet=”||30px||false|false” custom_margin_phone=”||||false|false” custom_margin_last_edited=”on|phone” text_font_size_tablet=”16px” text_font_size_phone=”16px” text_font_size_last_edited=”on|phone” global_colors_info=”{}”]Every insurance plan is different. Coverage for mental health treatment varies based on your specific plan, provider network, employer, and state regulations.<\/p>\n
Even two people insured through the same company may have different deductibles, copays, or provider networks. The steps below will help you understand how your own plan works.
\n[\/et_pb_text][et_pb_text module_id=”where-insurance” _builder_version=”4.27.5″ _module_preset=”default” text_font=”Nunito Sans|300|||||||” text_text_color=”#000000″ text_font_size=”16px” text_line_height=”1.4em” header_3_font=”BebasNeue Bold|–et_global_body_font_weight|||||||” header_3_text_color=”#79A2E6″ header_3_font_size=”32px” header_3_line_height=”1.1em” background_color=”rgba(255,255,255,0.7)” width_tablet=”” width_phone=”” width_last_edited=”on|phone” max_width=”750px” custom_margin=”||3px||false|false” custom_margin_tablet=”||30px||false|false” custom_margin_phone=”||0px||false|false” custom_margin_last_edited=”on|phone” custom_padding=”40px|40px|40px|40px|false|false” hover_enabled=”0″ text_font_size_tablet=”16px” text_font_size_phone=”15px” text_font_size_last_edited=”on|desktop” border_radii=”on|40px|40px|40px|40px” global_colors_info=”{}” sticky_enabled=”0″]<\/p>\nWhere To Find Your Plan\u2019s Information<\/h3>\n
Your health insurance company\u2019s online customer portal is a good place to find your plan benefits, progress toward meeting your deductible, and any other resources available through the insurance plan (such as health coaching, educational pamphlets, or a patient advocate<\/strong><\/a>).<\/p>\n
The portal should also contain a link to your entire plan details (not just the overview), although that document may be very lengthy and difficult to understand if you do not have a background in medicine.<\/p>\n
It is often easier to call your insurance company directly. There should be a “Patient Access” or “Customer Service” number on your insurance card. When you call, make sure you have something to write with so you can take down any necessary details.<\/p>\n
[\/et_pb_text][\/et_pb_column][et_pb_column type=”2_3″ admin_label=”Column” _builder_version=”4.27.5″ _module_preset=”default” custom_padding=”|||50px|false|false” custom_padding_tablet=”|||0px|false|false” custom_padding_phone=”|||0px|false|false” custom_padding_last_edited=”on|tablet” global_colors_info=”{}” custom_css_main_element_last_edited=”on|tablet” custom_css_main_element_tablet=”margin-bottom:0px !important;” custom_css_main_element_phone=”margin-bottom:0px !important;”][et_pb_text module_id=”insurance-questions” _builder_version=”4.27.5″ _module_preset=”default” text_font=”Nunito Sans||||||||” text_text_color=”#000000″ text_font_size=”16px” text_line_height=”1.4em” header_3_font=”–et_global_body_font|300|||||||” header_3_text_color=”#404041″ header_3_font_size=”30px” header_3_line_height=”1.2em” header_4_font=”|700|||||||” header_4_text_color=”#1F2B8E” header_4_font_size=”20px” custom_margin=”2px||0px||false|false” custom_margin_tablet=”||||false|false” custom_margin_phone=”||||false|false” custom_margin_last_edited=”on|desktop” custom_padding=”30px||||false|false” hover_enabled=”0″ text_font_size_tablet=”” text_font_size_phone=”14px” text_font_size_last_edited=”on|phone” custom_css_free_form=”selector ul li {|| margin-top: 18px;||}” border_width_top=”2px” border_color_top=”#FFFFFF” global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n
Questions to Ask Your Insurance Provider<\/h4>\n
- \n
- What is the deductible<\/a><\/strong> for my plan? How much of the deductible has already been met \/ how much remains?<\/li>\n
- Do I have out-of-network<\/strong><\/a> benefits? If so, what is the deductible? What is the coinsurance<\/strong><\/a> once the deductible has been met?<\/li>\n
- I \/ my family member has been recommended for a higher level of care<\/a><\/strong> (IOP, PHP, etc). Do we need prior authorization<\/strong><\/a> for this service? If so, who should my provider contact? Are there any facilities at this level of care near me that are in-network<\/a><\/strong>? Learn more about levels of care ><\/a><\/strong><\/li>\n
- What is the copay or coinsurance<\/a><\/strong> for this level of care? Does the deductible apply<\/strong><\/a>? If the deductible applies, what is the allowed amount<\/a><\/strong> for this level of care by this provider \/ this facility? (This will help you estimate how much you will pay for each office visit or day of treatment until your deductible has been met.)<\/li>\n
- Is there any limit on the number of psychotherapy sessions (or days at a higher level of care) covered by this plan? If so, can this be appealed if the services are still medically necessary<\/a><\/strong>? How?<\/li>\n
- Are psychotherapy sessions limited to a certain duration (i.e. 45 minutes vs 60 minutes)?<\/li>\n
- I have reached out to the in-network providers in my area and they are not taking new clients \/ they do not specialize in my diagnosis. I would like to see an out-of-network provider at in-network rates. Is this possible, and if so, what documentation is required and where do I send it?<\/li>\n
- Always make a note of the call reference number and the name of the person you spoke to before you hang up. This will be helpful in filing an appeal if your claim<\/a><\/strong> is denied<\/a><\/strong>, or following up on previous calls.<\/li>\n<\/ul>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row use_custom_gutter=”on” gutter_width=”1″ make_equal=”on” _builder_version=”4.27.4″ _module_preset=”default” use_background_color_gradient=”on” background_color_gradient_direction=”0deg” background_color_gradient_stops=”#ffffff 0%|rgba(148,156,161,0.25) 100%” positioning=”absolute” z_index=”0″ width=”100%” max_width=”100%” height=”25%” mix_blend_mode=”multiply” locked=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|phone” admin_label=”Section” module_id=”planning-guide” _builder_version=”4.27.5″ _module_preset=”default” background_color=”#efeae6″ custom_padding=”|50px|60px|50px|false|true” custom_padding_tablet=”|35px|20px|35px|false|true” custom_padding_phone=”30px|35px|20px|35px|false|true” hover_enabled=”0″ z_index_tablet=”0″ z_index_phone=”0″ z_index_last_edited=”on|desktop” da_disable_devices=”off|off|off” global_colors_info=”{}” sticky_enabled=”0″ da_is_popup=”off” da_exit_intent=”off” da_has_close=”on” da_alt_close=”off” da_dark_close=”off” da_not_modal=”on” da_is_singular=”off” da_with_loader=”off” da_has_shadow=”on”][et_pb_row column_structure=”1_3,2_3″ custom_padding_last_edited=”on|desktop” _builder_version=”4.27.5″ _module_preset=”default” width=”100%” custom_padding=”||||false|false” custom_padding_tablet=”0px||0px||true|false” custom_padding_phone=”0px||0px||true|false” z_index_tablet=”” z_index_phone=”” z_index_last_edited=”on|desktop” global_colors_info=”{}”][et_pb_column type=”1_3″ _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Planning Guide” admin_label=”Heading” _builder_version=”4.27.5″ _module_preset=”default” title_font=”BebasNeue Bold|–et_global_body_font_weight|||||||” title_text_color=”#1F2B8E” title_font_size=”40px” title_line_height=”1.2em” custom_margin=”||4px|||” custom_margin_tablet=”” custom_margin_phone=”” custom_margin_last_edited=”on|desktop” title_font_size_tablet=”36px” title_font_size_phone=”30px” title_font_size_last_edited=”on|desktop” global_colors_info=”{}”][\/et_pb_heading][et_pb_text _builder_version=”4.27.5″ _module_preset=”default” text_font=”Nunito Sans||||||||” text_text_color=”#000000″ text_font_size=”18px” text_line_height=”1.4em” header_3_font=”–et_global_body_font|300|||||||” header_3_text_color=”#404041″ header_3_font_size=”30px” header_3_line_height=”1.2em” header_4_font_size=”20px” width_tablet=”100%” width_phone=”100%” width_last_edited=”on|desktop” custom_margin=”||27px||false|false” custom_margin_tablet=”||30px||false|false” custom_margin_phone=”||||false|false” custom_margin_last_edited=”on|phone” text_font_size_tablet=”16px” text_font_size_phone=”16px” text_font_size_last_edited=”on|phone” global_colors_info=”{}”]<\/p>\n
About These Examples<\/strong><\/h4>\n
Once you understand your deductible, copay, or coinsurance structure, you can estimate potential costs.<\/p>\n
The numbers presented here are examples for educational purposes only. Your actual costs will depend on the specifics of your plan, the provider you see, and many other variables. Only your insurance company can verify your plan details.
\n[\/et_pb_text][et_pb_text _builder_version=”4.27.5″ _module_preset=”default” text_font=”Nunito Sans|300|||||||” text_text_color=”#000000″ text_font_size=”18px” text_line_height=”1.4em” header_3_font=”BebasNeue Bold|–et_global_body_font_weight|||||||” header_3_text_color=”#79A2E6″ header_3_font_size=”28px” header_3_line_height=”1.1em” background_color=”rgba(255,255,255,0.7)” width_tablet=”” width_phone=”” width_last_edited=”on|phone” max_width=”750px” custom_margin=”||1px||false|false” custom_margin_tablet=”||30px||false|false” custom_margin_phone=”||0px||false|false” custom_margin_last_edited=”on|phone” custom_padding=”40px|32px|40px|40px|false|false” hover_enabled=”0″ text_font_size_tablet=”16px” text_font_size_phone=”15px” text_font_size_last_edited=”on|desktop” border_radii=”on|40px|40px|40px|40px” global_colors_info=”{}” sticky_enabled=”0″]<\/p>\nSample Plan Details<\/h3>\n
In-network deductible:<\/strong> $1,000<\/p>\n
Office visit copay:<\/strong> $50<\/p>\n
Coinsurance:<\/strong> 90%<\/p>\n
Out-of-network deductible:<\/strong> $2,000<\/p>\n
Out-of-network coinsurance:<\/strong> 50%<\/p>\n
<\/p>\n
How to Estimate Costs<\/h3>\n
Deductible<\/strong> \u00f7 allowed amount<\/strong> =
\nnumber of sessions until I meet my deductible<\/p>\nCoinsurance<\/strong> x allowed amount<\/strong> =
\nhow much insurance pays after deductible is met[\/et_pb_text][\/et_pb_column][et_pb_column type=”2_3″ admin_label=”Column” _builder_version=”4.27.5″ _module_preset=”default” custom_padding=”|||50px|false|false” custom_padding_tablet=”|||0px|false|false” custom_padding_phone=”|||0px|false|false” custom_padding_last_edited=”on|tablet” global_colors_info=”{}” custom_css_main_element_last_edited=”on|tablet” custom_css_main_element_tablet=”margin-bottom:0px !important;” custom_css_main_element_phone=”margin-bottom:0px !important;”][et_pb_text admin_label=”Text” _builder_version=”4.27.5″ _module_preset=”default” text_font=”Nunito Sans||||||||” text_text_color=”#000000″ text_font_size=”16px” text_line_height=”1.4em” header_3_font=”–et_global_body_font|300|||||||” header_3_text_color=”#404041″ header_3_font_size=”30px” header_3_line_height=”1.2em” header_4_font=”|700|||||||” header_4_text_color=”#1F2B8E” header_4_font_size=”20px” custom_margin=”20px||16px||false|false” custom_margin_tablet=”||||false|false” custom_margin_phone=”||||false|false” custom_margin_last_edited=”on|desktop” custom_padding=”30px||||false|false” hover_enabled=”0″ text_font_size_tablet=”” text_font_size_phone=”14px” text_font_size_last_edited=”on|phone” custom_css_free_form=”selector ul li {|| margin-top: 10px;||}” border_width_top=”2px” border_color_top=”#FFFFFF” global_colors_info=”{}” sticky_enabled=”0″ header_4_line_height=”1.2em”]<\/p>\nScenario One: In-Network Provider With Copay<\/h4>\n
- \n
- Find a provider who is in-network. Confirm CPT codes<\/a><\/strong> used by provider (if possible).<\/li>\n
- Insurer verifies that the deductible does not apply for those CPT codes, and those are copay visits.<\/li>\n
- Insurer verifies you have a standard office visit copay of $50<\/li>\n
- Every time you visit your provider, you will pay $50. If you reach your out-of-pocket max<\/a><\/strong>, you pay $0.<\/li>\n<\/ul>\n
[\/et_pb_text][et_pb_text admin_label=”Text” _builder_version=”4.27.5″ _module_preset=”default” text_font=”Nunito Sans||||||||” text_text_color=”#000000″ text_font_size=”16px” text_line_height=”1.4em” header_3_font=”–et_global_body_font|300|||||||” header_3_text_color=”#404041″ header_3_font_size=”30px” header_3_line_height=”1.2em” header_4_font=”|700|||||||” header_4_text_color=”#1F2B8E” header_4_font_size=”20px” custom_margin=”20px||16px||false|false” custom_margin_tablet=”||||false|false” custom_margin_phone=”||||false|false” custom_margin_last_edited=”on|desktop” custom_padding=”30px||||false|false” hover_enabled=”0″ text_font_size_tablet=”” text_font_size_phone=”14px” text_font_size_last_edited=”on|phone” custom_css_free_form=”selector ul li {|| margin-top: 10px;||}” border_width_top=”2px” border_color_top=”#FFFFFF” global_colors_info=”{}” header_4_line_height=”1.2em” sticky_enabled=”0″]<\/p>\n
Scenario Two: In-Network Provider With Deductible<\/h4>\n
- \n
- Find a provider who is in-network. Confirm CPT codes used by provider (if possible).<\/li>\n
- Insurer verifies that deductible does apply for these services.<\/li>\n
- Ask insurer what the allowed amount (or contracted rate) is for [CPT code] billed by [NPI<\/a> if you have it, or provider name & education level].<\/li>\n
- Insurer verifies the allowed amount for that CPT code is $100.<\/li>\n
- You will pay $100 per visit until you meet the deductible. Remember that all approved in-network spending counts towards the deductible, even if you see multiple providers.<\/li>\n
- In ten sessions (or fewer), you have met your deductible. After that, you pay $10 per session until you reach your out-of-pocket max, and then you pay $0<\/li>\n<\/ul>\n
[\/et_pb_text][et_pb_text admin_label=”Text” _builder_version=”4.27.5″ _module_preset=”default” text_font=”Nunito Sans||||||||” text_text_color=”#000000″ text_font_size=”16px” text_line_height=”1.4em” header_3_font=”–et_global_body_font|300|||||||” header_3_text_color=”#404041″ header_3_font_size=”30px” header_3_line_height=”1.2em” header_4_font=”|700|||||||” header_4_text_color=”#1F2B8E” header_4_font_size=”20px” custom_margin=”20px||16px||false|false” custom_margin_tablet=”||||false|false” custom_margin_phone=”||||false|false” custom_margin_last_edited=”on|desktop” custom_padding=”30px||||false|false” hover_enabled=”0″ text_font_size_tablet=”” text_font_size_phone=”14px” text_font_size_last_edited=”on|phone” custom_css_free_form=”selector ul li {|| margin-top: 10px;||}” border_width_top=”2px” border_color_top=”#FFFFFF” global_colors_info=”{}” sticky_enabled=”0″ header_4_line_height=”1.2em”]<\/p>\n
Scenario Three: Out-Of-Network Provider<\/h4>\n
- \n
- Find a provider who is out-of-network. Session rate is $200.<\/li>\n
- Insurer verifies out-of-network benefits (with\/without) the need for prior authoritzation.<\/li>\n
- Ask insurer what the allowed amount is for [CPT code] billed by [NPI if you have it, or provider education level].<\/li>\n
- Insurer verifies the allowed amount for that CPT code billed by that provider is $100.<\/li>\n
- You will pay $200 per visit directly to the out-of-network provider.<\/li>\n
- Provider gives you a superbill<\/a><\/strong>, which you submit to insurance.<\/li>\n
- Insurance counts $100 (the allowed amount) per session towards your out-of-network deductible. The out-of-network deductible does not include the in-network spending you may have already made.<\/li>\n
- After 20 (or fewer) sessions, you have met your out-of-network deductible. Your insurance will then reimburse you $50 (50% of the $100 allowed amount) per session, and your out of pocket cost will be $150 per session.<\/li>\n<\/ul>\n
[\/et_pb_text][et_pb_button button_text=”Download PDF of Understanding Insurance” disabled_on=”on|on|on” admin_label=”Button” _builder_version=”4.27.5″ _module_preset=”default” custom_button=”on” button_text_size=”16px” button_text_color=”#1F2B8E” button_bg_color=”#FA9B1C” button_border_width=”0px” button_border_radius=”50px” button_letter_spacing=”0px” button_font=”|600|||||||” button_use_icon=”off” custom_padding=”10px|30px|10px|30px|true|true” button_text_size_tablet=”18px” button_text_size_phone=”14px” button_text_size_last_edited=”on|phone” disabled=”on” global_colors_info=”{}” button_text_color__hover_enabled=”on|hover” button_text_color__hover=”#FFFFFF” button_bg_color__hover_enabled=”on|desktop” button_bg_color__hover=”#1F2B8E” button_bg_enable_color__hover=”on”][\/et_pb_button][\/et_pb_column][\/et_pb_row][et_pb_row use_custom_gutter=”on” gutter_width=”1″ make_equal=”on” module_id=”cost-planning” _builder_version=”4.27.5″ _module_preset=”default” use_background_color_gradient=”on” background_color_gradient_direction=”0deg” background_color_gradient_stops=”#ffffff 0%|rgba(121,162,230,0.6) 100%” positioning=”absolute” z_index=”0″ width=”100%” max_width=”100%” height=”25%” mix_blend_mode=”multiply” locked=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ admin_label=”Column” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|desktop” admin_label=”Section” _builder_version=”4.27.5″ _module_preset=”default” background_color=”#efeae6″ use_background_color_gradient=”on” background_color_gradient_stops=”rgba(250,155,28,0.31) 0%|#f3efec 100%” custom_padding=”|50px|60px|50px|false|true” custom_padding_tablet=”|35px||35px|false|true” custom_padding_phone=”30px|35px|60px|35px|false|true” z_index_tablet=”0″ z_index_phone=”0″ z_index_last_edited=”on|desktop” da_disable_devices=”off|off|off” global_colors_info=”{}” da_is_popup=”off” da_exit_intent=”off” da_has_close=”on” da_alt_close=”off” da_dark_close=”off” da_not_modal=”on” da_is_singular=”off” da_with_loader=”off” da_has_shadow=”on”][et_pb_row custom_padding_last_edited=”on|desktop” _builder_version=”4.27.5″ _module_preset=”default” width=”100%” custom_padding=”||||false|false” custom_padding_tablet=”0px||0px||true|false” custom_padding_phone=”0px||0px||true|false” z_index_tablet=”” z_index_phone=”” z_index_last_edited=”on|desktop” global_colors_info=”{}”][et_pb_column type=”4_4″ admin_label=”Column” _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Insurance Resources” _builder_version=”4.27.5″ _module_preset=”default” title_font=”BebasNeue Bold|–et_global_body_font_weight|||||||” title_text_color=”#1F2B8E” title_font_size=”40px” title_line_height=”1.2em” custom_margin=”||4px|||” custom_margin_tablet=”” custom_margin_phone=”” custom_margin_last_edited=”on|desktop” title_font_size_tablet=”36px” title_font_size_phone=”30px” title_font_size_last_edited=”on|desktop” global_colors_info=”{}”][\/et_pb_heading][et_pb_code _builder_version=”4.27.5″ _module_preset=”default” global_colors_info=”{}”]\t
\n \n
- Do I have out-of-network<\/strong><\/a> benefits? If so, what is the deductible? What is the coinsurance<\/strong><\/a> once the deductible has been met?<\/li>\n
- Where to Find your Plan’s Information<\/a><\/strong><\/li>\n
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\n \t\t\t\t\t\t\t\t \t\t\t\t\t\t\t<\/div>\n \t\t\t\t\t\t\t<\/a>\n \n \t\t\t\t\t\t\t