Understanding Your Deductible

Deductibles are a crucial part of health care services. This amount describes the amount you must pay for services before your provider assists you with coverage. Your deductible can change depending on the plan you select and it can affect which providers you seek for services. Understanding your deductible will help you find the best health care services and providers to address your concerns in the best way possible. Learn more about your health insurance deductible here.

How Do Deductibles Work?

A deductible is the amount you owe for health care services before your health insurance pays. Deductibles differ from premiums, which is the amount you pay for insurance. The plan you choose will affect your deductible amounts and whether you have low or high out-of-pocket costs. For example, if your deductible is $1,000, you must pay 100% of eligible expenses until your total reaches $1,000. At that point, you will share the cost of medical expenses with your insurance provider.

Typically, if you have a high deductible plan, you will pay less for your insurance each month but spend more money covering the costs of individual services. Low deductible plans will often feature higher monthly fees for insurance but lower out-of-pocket costs.

It’s essential to recognize that understanding your deductible is your responsibility. Only your provider can tell you how much you owe for a deductible. If you have any questions about your insurance plan or deductible, you must contact your health insurance company for more information.

For example, if you have a question about a bill from your care provider, you may need to contact your insurance provider. Care providers will bill whatever amount your insurance provider authorizes. This means that if your insurance provider denies a claim or only covers part of the total, you will have to cover the remainder cost. In some cases, insurance providers may decide to cover a previously denied claim after you reach out to them. You may need to contact your care provider’s billing department with a reference number so they can resubmit the claim on your behalf.

Additionally, some care providers may only offer in-network services. Some patients can seek out-of-network care if their insurance plan allows them. However, you must confirm this by speaking with your insurance provider.

Deductible and Insurance Term Glossary

Your health plan and insurance coverage will often feature various terms that describe how much you owe, who you owe money to or when you need to pay. These terms help you understand your policy, so understanding each is essential. Here you can find some common terms regarding your health coverage:

• Allowed amount: This term refers to the maximum payment your plan will pay for a health care service. Some providers may also refer to this amount as negotiated rate, payment allowance or eligible expense.
• Balance billing: Your provider will bill you for the remaining balances on bills that your policy doesn’t cover. The balance billing amount will be the difference between the allowed amount and the actual billed amount.
• Claim: A claim is a bill you or your provider will submit to the insurance company to seek reimbursement.
• Coinsurance: Coinsurance describes the percentage of the allowed amount your share of health care service costs will be. Typically, you will pay any deductibles you owe alongside coinsurance. For example, if you have a $100 allowed amount for a service and have met your deductible, your coinsurance could be 20%, which indicates you would pay $20 for your service while your plan covers the rest of the allowed amount.
• Copayment: A copayment is a designated amount you will pay for a service. This total can vary between different service types. For example, you may have a $20 copay for office visits and a $35 copay for specialist visits.
• Medically necessary: Any service or supplies you need to treat, prevent or diagnose an illness, disease or condition or symptoms will be medically necessary if they meet the accepted standards of medicine.
• Network provider: Providers with contracts with your health insurance provider who agrees to provide care to plan members are known as network providers. You will often pay less to visit a network provider than an out-of-network provider. You may also see “participating provider” or “preferred provider” describing network providers.
• Out-of-network provider: A provider without a contract with your plan is known as an out-of-network provider. Some plans will cover services from out-of-network providers, but they will typically be more expensive than seeing a network provider. Your policy will establish what these costs may be.
• Out-out-pocket limit: This amount refers to the maximum amount you can pay in one year for coinsurances, copays and deductibles. Once you reach this limit, your provider will provide 100% coverage for your health care services.
• Rehabilitation services: Services that aid people in improving, regaining or maintaining skills and functioning for daily life are rehabilitation services. Loss of these skills or functions could result from sickness, injuries or disabilities, and these services could include physical therapy, occupational therapy and psychiatric rehabilitation.
• Specialist: A provider who focuses on a specific type of medicine or helps patients prevent, treat, manage or diagnose certain conditions and symptoms is a specialist. Depending on your plan, you may need to pay more for your deductible for therapy to visit a specialist.

Understanding Your Insurance Deductible for Therapy

Seeking mental health help is important, and finding the best provider to meet your needs will help you get back on track and take control of your life. When seeking therapy, you have several payment options.

You may consider any in-network therapist to keep your regular visits at an affordable cost. This can be an affordable way to seek help if your deductible does not affect your copay or if you’ve had many medical expenses throughout the year.

You can also seek out-of-network providers — this option allows you to have a larger pool of options to ensure you find someone to meet all your needs. Although you can expect to pay more for your sessions, you can ensure you find the perfect match to address your concerns. This option is excellent for people with good out-of-network benefits or those who need to find specialized therapies.

Sometimes, meeting your deductible does not mean your insurance provider won’t apply your session to your deductible. For instance, if you have an extensive procedure at the start of the week to meet your deductible but visit another care provider a few days later, you could still receive a bill for that second appointment. It’s important to note that your insurance provider will decide when you meet your deductible.

For instance, your provider may receive your therapy session bill before the procedure bill, meaning you will owe for the therapy session even though it was a later appointment. If you think you received a statement by mistake or have questions about your total, contact your insurance provider by calling the number on the back of your insurance card.

Contact MV Psych to Begin Therapy in MA

Life can become overwhelming when difficult decisions surface. At Merrimack Valley Psychological Associates, you can find the help you need to overcome those challenging moments. We’re dedicated to helping families, adults, adolescents and children facing a variety of challenges. Our skilled and compassionate therapists specialize in making you feel comfortable. We accept Blue Cross Blue Shield OPTUM/United Healthcare/United Behavioral Health and most OPTUM affiliates in-network. We are also are proud to be an out-of-network provider for those on a PPO health plan.

We offer teletherapy lessons to be more accessible for everyone seeking help from the comfort of their homes. You can also visit us at our Andover office for a respectful and authentic environment dedicated to addressing your concerns and helping you overcome the hurts you’re facing.

We proudly offer a wide range of therapy services, including:

• Anxiety counseling
• Depression counseling
• Stress management
• Addiction resources
• Learning disabilities
• Managing anger
• Grief and loss

Whether you’re facing everyday anxieties or have a mental health concern, our team is ready to help. Professional help can be life-changing, and we want to help you get back on track. Contact us to get in touch with a caring team member.