(Please  note that this information is not an accurate reflection of each person’s benefits, but a general overview intended to help you navigate the world of insurance.)

Allowed Amount: Or “negotiated rate,” is the maximum amount that your insurance company will pay for a covered service based on your plan. If the allowed amount your plan pays for mental health services is $100, for example, and your therapist charges $125 per session, the therapist would write off or not charge the additional $25.

Co-Payment: Some plans require a copay, not all plans though. This is a fixed amount that you are responsible for paying when receiving health care services that are covered by insurance. 

Co-Insurance: This is similar to a Co-Payment but is often reflected as a percentage. For example, a 20% co-insurance means that you would pay 20% of the allowed amount. This can vary depending on your specific plan and other factors such as if you have met your deductible.

Deductible: This is often the amount you have to pay for health care services before your insurance begins any reimbursement. Every plan is different. So for example, let’s say your insurance covers 80% for each therapy session, but only after you reach a $1,000 deductible. If the allowed amount for each session is $100, you would have to pay for 10 sessions before you reach your deductible ($100 per session x 10 sessions = $1,000). In this case, after reaching your deductible your insurance would reimburse $80 (80% of $100) and you would be responsible for a $20 balance. Please note that every plan is different. Deductibles can be varying amounts and the amount that your specific insurance will cover after meeting your deductible can vary as well. It is also important to note that your deductible applies to all medical treatment and is not specific to mental health. This means that if you go to the doctor and have to pay a portion towards your deductible that this amount is calculated in the overall amount you have put towards your deductible. 

Family Deductible: If you are under a family plan, the family must collectively reach a certain amount before getting reimbursed by the insurance company.

In-Network Providers: These are health care providers that have a contract with your insurance company. They are only permitted to charge the client the agreed upon amount per their contract.

Out-of-Network Providers: Health care providers who are not contracted with your insurance company. 

Out-of-pocket Maximum: This is the most you will spend on covered services during the policy year, after which your insurance will pay for 100% of the services covered under the plan.

Secondary Insurance: If you have two insurances, this refers to the second insurance. If you have a medicaid plan, this is always the secondary insurnace. This process is a little more complicated and time consuming. Your provider will first submit the claim to your primary insurance. After this insurnace company has processed the claim it will then be submitted to your secondary insurance company.