Health Insurance Vocabulary Words

Whether you're thinking about starting therapy or are already in therapy, understanding your health insurance is vital to making sure that your mental health care is accessible to you. Your provider might provide you with their understanding of your benefits, but it's important to always double-check your plan to make sure that you're on the same page.

Here are some common terms used in health insurance plans and what they might mean for your therapy sessions:

Claim: This is a request for payment that your therapist sends your insurance company. It's a type of "invoice" that describes what services were provided and why they were necessary. When claims are approved, insurances will provide payment and cover your session (to varying degrees based on your plan). When claims are denied, you are often responsible for the cost of the session. Claims may be denied for a variety of reasons, but part of your therapist's job is to justify why the session was necessary.

In-network: These therapists are "in" your health insurance's network. They have a pre-existing relationship, so your insurance will cover a larger portion of each session's cost.

Out-of-network: These therapists are "out" of your health insurance's network. They do not have a pre-existing relationship, so your insurance will often cover little to no part of each session's cost. Some therapists may provide you with a "superbill" that you can submit to your insurance for reimbursement.

Superbill: Think of a superbill like a receipt. A superbill is an itemized report of your session, including the relevant billing codes and information for your insurance company to process an out-of-network claim.

Deductible: This is the yearly monetary cap that you must pay out-of-pocket for all health-related expenses before your insurance company will cover any costs. Sometimes, deductibles are "waived" for mental health services so that you can just pay your copay each session. Some plans have very high deductibles, some plans have no deductibles, some plans reset their deductibles on January 1st, other plans reset their deductibles one year from the day you began the plan.

Copayment (copay): The copay is a flat amount that you are responsible for at each time of service, after your deductible has been met. Your deductible might be waived, which means you'll start paying your copay rather than the full cost of service even before you've hit your deductible. For example, you might have a $20 copay with a waived deductible, so each therapy session would cost you $20 out of pocket while your insurance covers the rest.

Coinsurance: Unlike a copay, coinsurance is a percentage rate of the cost of service. The same deductible rules apply. For example, if your coinsurance is 30%, your deductible is waived, and a therapy session is $100, you will pay $30 and your insurance will cover $70.

If you're still unsure of how these might play into your own health insurance plan, contact your insurance directly and ask to discuss your benefits for outpatient mental health services.