Understanding Your Insurance Coverage for Therapy Services
Navigating insurance can be particularly challenging when it comes to mental health services, including therapy and psychiatric care. Unlike standard doctor visits, mental health services are often covered under different terms, leading to unexpected costs or limitations. To help you get the most out of your coverage, we’ve compiled this simple guide on the ins and outs of using your insurance for therapy.
Know the details of your coverage ahead of time
Always verify your benefits with your insurance company before scheduling any appointments. This step helps you avoid unanticipated out-of-pocket costs and ensures you’re fully aware of what’s covered.
What insurance networks are accepted at The Care Clinic?
The Care Clinic works with a broad spectrum of health insurance plans, although coverage varies by location.
If we’re not currently in-network with your insurance provider, rest assured—we’re actively working to expand our partnerships to make mental health care more accessible for everyone. In the meantime, you may still be eligible for potential reimbursement through our Superbill process. Simply email us at payments@careclinicmd.com to request a superbill, and then submit it to your insurance provider for reimbursement.
How do I contact my insurance provider?
Your insurance card will typically have a “Member Services” or “Customer Service” phone number listed, usually found on the back of the card. When you call, have your ID number, full name, date of birth, and social security number ready to provide.
Ask the representative for a cost estimate on outpatient mental health services, and be prepared to provide the location details by accessing this link See All Our Locations Here.
Common insurance terms explained
When managing your insurance, you may encounter various terms that can be confusing. Here’s a guide to some of the most important terms you need to know.
What is a Copay?
A copay is a fixed fee that you pay each time you receive a specific healthcare service, such as a therapy session. If your insurance plan states that mental health benefits are subject to a copay, you’ll pay the same amount per session, no matter what type of care you receive or how your provider bills the service using CPT code(s). This means that whether your visit is for a basic consultation or a more complex therapy session, the cost remains the same.
What is a Deductible?
A deductible is the amount of money you have to pay out-of-pocket for healthcare services before your insurance starts covering costs. Think of it as a starting point—once you’ve paid the full deductible amount, your insurance will begin to share the costs with you.
There are two types of deductibles:
- Individual Deductible: Each person on your plan has a separate deductible amount that must be met before insurance starts covering their healthcare expenses.
- Family Deductible: All members of the plan contribute to a shared deductible amount. Once this collective amount is met, the insurance coverage extends to everyone in the family.
Deductibles usually reset each year or when you switch to a new insurance plan.
⚙️ How Does it Work?: Let’s say your deductible is $1,500. This means you’ll be responsible for paying all eligible healthcare costs until you reach $1,500. After that, your insurance will begin to cover part of the expenses, and you’ll only pay a portion of the remaining costs through something called “coinsurance.”
What is Coinsurance?
Coinsurance is your share of healthcare costs that you pay after you’ve met your insurance plan’s deductible. It’s typically represented as a percentage of the allowed amount for each service. For example, if your plan has an 80/20 coinsurance, your insurance pays 80% of the covered expenses, and you are responsible for the remaining 20%.
This cost-sharing continues until you reach your annual out-of-pocket limit.
⚙️ How does it work?: Once you meet your deductible, coinsurance begins. This means instead of paying the entire bill yourself, you and your insurance company split the cost based on the percentage set by your plan.
Let’s say you’ve already paid your $1,500 deductible for the year, and now you need to see a doctor for a $100 appointment. If your plan has an 80/20 coinsurance, your insurance will cover 80% of the cost ($80), and you will be responsible for 20% ($20).
What is an Out-of-Pocket Maximum/Limit?
Your out-of-pocket maximum is the maximum amount you will spend on covered healthcare services in a year. After reaching this limit, your insurance covers 100% of covered healthcare costs.
What’s Included in Your Out-of-Pocket Limit?
Your out-of-pocket maximum may include the following expenses (note: depending on your plan, your insurance may not include these expenses when calculating your out-of-pocket limit):
- Deductibles: The amount you pay before your insurance starts covering services.
- Copayments: The fixed amount you pay for specific healthcare services.
- Coinsurance: The percentage of costs you share with your insurance company after meeting your deductible.
What’s NOT Included in Your Out-of-Pocket Limit? Certain costs are not included in your out-of-pocket maximum:
- Monthly Premiums: These are the regular payments you make to keep your insurance coverage active.
- Services Not Covered by Your Plan: Any expenses for healthcare services your plan doesn’t cover will not count toward your out-of-pocket maximum.
- Out-of-Network Services: Most insurance plans do not apply expenses for out-of-network care toward your out-of-pocket limit unless otherwise specified.
⚙️ How does it work?: For example, if your out-of-pocket maximum is $7,500, you will need to pay this amount through deductibles, copayments, and coinsurance before your insurance starts covering 100% of the costs. If you reach $7,500 in spending throughout the year, you won’t have to pay any additional out-of-pocket costs for covered services, and your insurance will take care of the remaining bills for the rest of the plan year.
Frequently Asked Questions About Insurance Coverage
Do you have dual coverage?
If you have coverage under more than one insurance plan, it’s important to ensure your primary insurance provider has all the information about your secondary insurance on file. This is done through a Coordination of Benefits (COB) update. Many insurers require you to complete this update so they know how to coordinate payments between both plans. Without this step, your claims may not be processed correctly, which could leave you responsible for costs your secondary insurance would typically cover.
What you need to do:
- Contact your primary insurance provider: Call the “Member Services” or “Customer Service” number on the back of your primary insurance card and request to update your Coordination of Benefits (COB).
- Provide necessary information: Be ready to share your secondary insurance details, including the policy number, group number, and the name of the insurance company.
- Send us your secondary insurance card: Email a copy of your secondary insurance card to our client billing support team to ensure your billing is accurate. This will prevent you from being charged solely under your primary plan’s coverage and helps us correctly process claims with both insurers.
Are you Out-of-Network?
If your insurance plan is considered out-of-network for our services, you will be billed at our self-pay rate. Our fees typically range from $150 to $200 per session, varying based on the location and type of service. We accept all major credit cards, and for added convenience, you may also pay online via the PAYMENTS tab on our website.
If you would like to seek reimbursement for your visit, you can request a superbill or a detailed billing statement. This document can be submitted to your insurance company to potentially reimburse your visit fees.
Please note that self-pay visits do not count toward your insurance deductible. If you have any questions or need more specific information, feel free to speak with one of our care coordinators, who will be happy to assist you.
What factors determine the cost of my therapy session?
The cost of each therapy session at The Care Clinic is influenced by several factors such as your specific insurance coverage, the qualifications of your therapist, the geographical location, and the duration of the session.