Insurance FAQs

What's the difference between a HMO, PPO, FSA, and HSA? How do I figure out what I have?

These are all different types of health insurance plans. 

HMO (Health Maintenance Organization) - tend to be more cost effective but with less flexibility, you must choose a primary care provider (PCP) who will provide you referrals to specialists. Smaller network of in-network providers & pre-authorizations typically needed for specialist care. Better for those looking for preventative care. 

PPO (Preferred Provider Organization) - typically more expensive than HMOs but provides more flexibility. You don't have to choose a primary care provider, and you can see specialists without a referral. Out of pocket costs like copays/coinsurance may be higher than an HMO. This is typically a better option for those with chronic conditions or seeking specialized care.

FSA (Flexible Spending Account) - This is technically not a plan type but rather a special spending account that you can put money into without being taxed to use on out-of-pocket health care costs. These are typically offered through your employment, and the funds do not roll over from year to year.

HSA (Health Savings Account) -  This is a savings account used with a high-deductible health insurance plan, which means your annual deductible is higher than $1,400 for an individual plan or $2,800 for a family plan. Your health insurance coverage doesn't kick in until you meet the annual deductible, but they compensate for this cost by having you pay a lower monthly premium for the insurance. Unlike a FSA, your money rolls over from year to year.

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Your health insurance ID card should tell you what plan you have. If you're still not sure, you can call the insurance company directly to ask. Most insurance companies will also have a way for you to create an online account or access to an app, which should also show you details of your plan.

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What's a deductible?

Some insurance plans require that you meet a yearly deductible, meaning you'll have to pay out of pocket up to a certain amount each year before your insurance benefits kick in. Depending on your plan, it can be a few hundred to a couple thousand dollars. If you're not sure if you have a deductible, you can look up your plan coverage information based on the plan listed on your insurance ID card. 

 

What's a copay?

This is the amount that you pay the service provider at each session or office visit and is pre-determined by your insurance plan. Typically, your copay for therapy will range between $10-$40 per session for in-network services depending on your plan, and your insurance company will cover the rest.

 

What does in-network vs out-of-network mean?

Insurance plans have networks of providers that they have contracts with, typically meaning you will pay less for services with those specific in-network providers. You can search for who is in network with your insurance plan on your insurance companies' website. 

You can still technically see out-of-network providers, but this typically means you'd have pay for the full cost of services up front, and then file for reimbursement with your insurance company after the fact. The reimbursement you receive back from the insurance company will typically be a lot less than if you saw an in-network provider. 

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What's co-insurance?

This is kind of like a copay but is typically the percentage of the total fee of the service you're receiving. For example, some plans may say you have a 30% coinsurance for a doctor visit, so if you have 

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What's a superbill?

A superbill is an invoice or statement that is specifically for out-of-network clients who are seeking insurance reimbursement for their services. This invoice has an itemized list of all services provided to the client, including the charges/payments & dates of service. This is then submitted to the client's insurance company for reimbursement, which may take up to several weeks.​

In-network clients do not have to have submit superbills, which is why it's typically recommended that you see someone in your insurance network to save time/cost.

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What's an EOB?

An EOB, or Explanation of Benefits, is a document your insurance company will send to you after an insurance claim has been made for a specific service. It'll let you know how much your copay/coinsurance was, how much was paid to the service provider, and if the claim was denied, a reason for the denial. If the claim was denied, you are able to submit an appeal to the insurance company. These EOBs are typically mailed to you unless you opt into paperless EOBs online.

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I'm covered under my parents' insurance plan. Can they see if I'm receiving therapy services?

This is a tricky question, it depends! If you're over 18, you may be able to call your insurance company and request that EOBs (Explanation of Benefits) and other bills be sent to your address instead of your parents. However, your parents may still have access as the primary account holder if they have access to EOBs online. 

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When am I no longer covered by my parents' insurance?

When you are over 26 years old and/or they're unable to claim you as a dependent on their taxes.