Therapy Fees and Services

In-Network Insurance

Understanding Insurance

In-Network

In-Network refers to healthcare providers (like doctors or therapists) that have an agreement with your insurance company. These providers have agreed to provide healthcare services to you at a certain price that is negotiated between the provider and your insurance company.

When you go to an in-network healthcare provider, it means that your insurance company will help cover the cost of your healthcare services. This can include things like doctor visits, hospital stays, or therapy sessions.

Because in-network providers have an agreement with your insurance company, you may be responsible for paying only a portion of the cost of your healthcare services, called a co-payment or co-insurance. The amount you pay depends on your insurance plan and the type of service you receive.

When it comes to therapy, an in-network therapist is one who has an agreement with your insurance company to provide therapy services at a negotiated price. If you see an in-network therapist, your insurance company may cover a portion of the cost of your therapy sessions, and you'll likely only be responsible for paying a co-payment or co-insurance.

It's important to note that not all healthcare providers are in-network with every insurance company. If you see an Out-of-Network provider, your insurance company may cover a smaller portion of the cost of your healthcare services, or you may be responsible for paying more out of your own pocket.

To make sure you're getting the most out of your insurance benefits, it's a good idea to check with your insurance company to find out which healthcare providers are in-network for your plan.

Out-of-Network

Out-of-Network (OON) care refers to healthcare services from providers not contracted with a patient's insurance company. In contrast, In-Network care refers to services received from providers who are contracted with a patient's insurance company.

When a patient receives Out-of-Network care, their insurance company may not cover the full cost of the services received, leaving the patient responsible for paying the remaining costs out of pocket. In contrast, when a patient receives In-Network care, their insurance company generally covers a larger portion of the costs, resulting in lower out-of-pocket expenses for the patient.

It's important to note that some insurance plans offer Out-of-Network benefits, which means they will cover a portion of the costs for Out-of-Network care. However, these benefits may be subject to certain limitations, such as higher deductibles, co-payments, or coinsurance.

Only plans that are labeled as PPO are eligible for Out-of-Network benefits. If you have an HMO, you must see a provider in-network.

If you want to see if you have Out-of-Network benefits, please download the form below and call the number on the back of your insurance card.

Deductible

A deductible is a special amount of money that you have to pay before your insurance starts helping you pay for certain things, like healthcare. It's like a fee you have to pay first.

For example, let's say you have a health insurance plan with a $500 deductible. If you get sick and go to the doctor, you will have to pay the first $500 of your medical bills yourself. After you pay the deductible, your insurance will start helping you pay for the rest of your medical bills, but you'll still have to pay a portion of the cost, called a co-payment or co-insurance.

The deductible amount can vary depending on your insurance plan, and some plans don't have a deductible at all. It's important to understand how your deductible works so you can plan for the cost of your healthcare.

When it comes to therapy, your insurance may require you to meet your deductible before they will start helping you pay for the cost of your therapy sessions. This means you'll have to pay the full cost of your therapy sessions out of pocket until you meet your deductible.

Once you meet your deductible, your insurance may cover a portion of the cost of your therapy sessions, but you may still be responsible for paying a co-payment or co-insurance. Again, the specific details will depend on your insurance plan, so it's important to check with your insurance provider to understand your benefits and any out-of-pocket expenses you may be responsible for.

Out-of-Pocket Maximum

An Out-of-Pocket Maximum is like a limit on how much money you have to pay for healthcare expenses in a year. It's like a cap on how much you have to spend.

For example, let's say you have a health insurance plan with an Out-of-Pocket Maximum of $2,000. If you get sick and have to go to the doctor a lot, you might end up spending a lot of money on medical bills. But once you reach your Out-of-Pocket Maximum, your insurance company will start paying for all of your covered medical expenses for the rest of the year.

This means that once you reach your Out-of-Pocket Maximum, you won't have to pay any more money out of your own pocket for covered healthcare expenses for the rest of the year.

When it comes to therapy, your Out-of-Pocket Maximum may include the cost of your therapy sessions, along with other healthcare expenses like doctor visits and medications. So, if you reach your Out-of-Pocket Maximum, your insurance company will start covering the full cost of your therapy sessions.

Not all insurance plans have an Out-of-Pocket Maximum, and the amount of the Out-of-Pocket Maximum can vary depending on the insurance plan. It's important to check with your insurance provider to understand your benefits and any out-of-pocket expenses you may be responsible for.