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  • Janine Kesterson-Cravens

Knowing Your Insurance

Updated: Jun 2, 2021

When going to any appointment it is important to know what your insurance will pay and what you will be left owing. You might be asking yourself how do I do this? With most insurance plans you can either call the insurance company or go on their website and login to see your benefits. Note, insurance benefits are not always the same for mental health services as they are for medical services. Another important note is that you may have a carve out policy. For example, your health insurance is covered by BCBS and your mental health coverage is UMR. This is important to know because your mental health provider may not be in-network with your carve out plan leaving you to pay private pay rates.

Important Terms to know

Individual Deductible- individual meets their individual deductible, after-deductible benefits kick in and begin to pay healthcare expenses for that individual only, but not for the other family members.

Family Deductible- family deductible, coverage begins for each individual member as soon as his or her individual deductible is met.

Copay- Copays are a fixed amount you pay to see your doctor or a specialist. No matter how many copays you make they generally don't count toward your deductible and you continue to pay them even after your deductible has been met.

Coinsurance- Coinsurance is the amount, generally expressed as a fixed percentage, an insured must pay against a claim after the deductible is satisfied. In health insurance, a coinsurance provision is similar to a copayment provision, except copays require the insured to pay a set dollar amount at the time of the service.

Out of Pocket Maximum- The out-of-pocket maximum, on the other hand, is the most you'll ever spend out of pocket in a given calendar year.

Carve Out Plan- A carve-out insurance plan is a supplement to a person's standard health insurance plan. The carve-out plan is provided by a third-party vendor, and it covers specialized care or products, such as mental health coverage. (most carve out policies for mental health are Beacon and UMR).

In Network (IN)- In-network health care providers have contracted with your insurance company to accept certain negotiated (i.e., discounted) rates

Out of Network (OON)- Out-of-network providers have not agreed to the discounted rates and you often pay private pay rates.

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