Using Insurance...
...can put you in all kinds of moods...
Before you begin
Confirm Insurance Coverage
Most health insurance plans include mental health and substance use treatment. Typically insurance cards limit information on them and don't include details about your benefits, copay or co-insurance amount, or if your mental healthcare is managed by a different company than the one showing on your card. Before you start, always confirm your coverage with your insurance provider before scheduling any appointments. This step ensures you won't face unexpected out-of-pocket expenses.
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How do I contact my insurance company?
Look for the "Member Services" or "Customer Service" number on your insurance card, usually found on the back. When you call, have your ID number, name, date of birth, and social security number ready.
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If you want to speak to someone about this, please give us a call at (213) 531-0291 to speak with a enrollment specialist to help you confirm coverage!
Common Terms Explained
Copay
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Deductible
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Co-insurance
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Out-of-Pocket Maximum/Limit
Understanding insurance can be overwhelming, especially with all the technical terms. Here’s a simple guide to help you understand some of the most important and common terms you might encounter.
What is a Copay?
A copay is a fixed amount you pay for each service. If your plan includes a copay for mental health services, each therapy session will cost the same amount, regardless of the specific services provided.
Definition: The Current Procedural Terminology (CPT®) codes are a standardized language used by doctors and healthcare professionals to describe medical services and procedures. This helps ensure accuracy and efficiency in reporting.
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What is a Deductible?
A deductible is the amount you need to pay for healthcare services before your insurance starts to cover costs. You may have an individual deductible for yourself or a family deductible that applies to everyone on your plan. Deductibles usually reset every year or when you start a new plan.
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How it works: If your deductible is $1,500, you will pay the full cost of eligible healthcare expenses until you reach $1,500. After that, you share the costs with your insurance through coinsurance.
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What is Coinsurance?
Coinsurance is your share of the costs for healthcare services, usually expressed as a percentage. You start paying coinsurance after you have met your deductible.
How it works: Once you've paid your deductible, for example, $1,500, you will start sharing costs with your insurance. If your insurance covers 80% of a service, you will pay the remaining 20%. For instance, for a $100 therapy session, your insurance would pay $80, and you would pay $20.
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What is an Out-of-Pocket Maximum/Limit?
The out-of-pocket maximum is the most you will have to pay for covered services in a plan year. After you reach this limit, your insurance pays 100% of the costs for covered benefits.
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How it works: If your out-of-pocket limit is $7,500, once you've spent that much on services, your insurance will cover all additional costs for the rest of the year. This amount does not typically include your monthly premiums, costs for services not covered by your plan, or out-of-network services.