Navigating and utilizing your insurance policy can be tricky and confusing. It's likely that nobody ever explicitly taught you how to understand your benefits, or that it was too much information to grasp at the time. If you have benefits, I want to help you make the most of them.

Who am I in-network with?

I am considered an in-network provider for

I am considered in-network with any subsidiaries of these, such as Meritain Health.

Your insurance provider needs information about me to verify coverage. Here are the answers.

If your insurance provider wants to verify whether I am an in-network provider, or needs additional information for pre-authorization, it is typically this:

Key Insurance Terms

These terms will come up repeatedly in your understanding of your insurance benefits, so here is an overview of what they mean:

Example Insurance Usage

To better understand how insurance benefits might work, here is an example:

Let's say that your benefits include:

Let's say that you injured your knee playing sports, and need physical therapy. Your physical therapist is in-network, and their insurance-negotiated rate turns out to be $100. You go to this physical therapist 10 times until your knee is healed. You will have paid $1,000 for these sessions, and it will count towards your deductible. You use your HSA card for this. You now have $1000 left of your deductible, and $3000 left of your out-of-pocket max.

Let's say that a few months later, you decide to start therapy. This therapist is out-of-network, and their rate is $150 per session. You will be responsible for all of that rate, but can still pay using your HSA card and it will count towards your out-of-pocket max. You see this therapist for 6 sessions before you decide it isn't a good fit. You now have $1000 still left of your deductible (since they were out-of-network), but only $2100 left of your out-of-pocket max ($3000 minus the $900 for the 6 sessions). 

You then switch to an in-network therapist to continue treatment. Their in-network rate ends up being $100 (how convenient). You like this therapist, and see them for 14 sessions. After paying 10 sessions at the $100 rate using your HSA card, you have hit your deductible, and your fee drops to $25 (your deductible) for the subsequent 4 sessions, which you continue to charge to your HSA card. At this point, you have no remaining deductible to meet, and your remaining out-of-pocket amount is $1000 ($2100 minus the $1100 for the 14 sessions).

Finally, you decide to also complete a psychological evaluation to clarify what might be going on. The testing psychologist is out-of-network, and charges $200 per hour. As you meet, you pay for 5 hours of their time ($1,000), but then meet your out-of-pocket limit. You no longer need to pay anything yourself, as your insurance will cover any remaining medical costs for that year.

What should you know about your benefits before starting therapy?

To be financially prepared, here is a list of helpful things to know:

These answers may be found through your insurance provider's handbook or online portal. It is also possible to call the phone number on the back of your insurance card to talk to a representative.

What should you know about your benefits before starting an assessment?

Psychological assessment services generally follow the same procedure with insurance as therapy services, but with a few extra components.

You'll still want to ask the questions about deductible, copay or co-insurance, and out-of-pocket maximum as you would for seeking therapy services. However, it's a good idea to also ask the following:

With this information, you can then use this Assessment Charge Calculator to estimate what you might expect to pay for all of the assessment-related services. 

The exact balance will depend on what your insurance sets as their allowable amounts for any given service, the number of units (aka the amount of time) needed for your specific case, and if the obtained insurance information is accurate.